Join Now Step 1 of 2: Fill out your membership form Membership and Endorsement Renewals for 2025 for renewals 10/1/24 to 12/31/24 NJ-AIMH memberships and Endorsements are renewed annually on a calendar year. Renewal applications received from October 1 will be in effect until December 31 of the following year. I would like to * Join or Renew annual membership for 2025 ($35) Join or Renew student membership for 2025 ($15) I am a Lifetime Honorary Member (No fee) My Info First Name * Last Name * Personal Email Address * My Work email * Preferred Email address for NJ-AIMH Messages * Personal Work Home Address * City * State * Zip * My Cell Phone Number * Name of Agency/Employer/Affiliation * Job Title * My Work Phone Number * Discipline, e.g., early childhood education, social work, psychology, nursing, pediatrics, counseling, OT, speech therapy, etc. * I identify racially/ethnically as: * Asian Bi-racial Black Indigenous Latinx Multi-racial White OtherOther I prefer not to answer. I use the following pronouns: * he/him/his he/they/their she/her/hers she/they/their they/them/their OtherOther I prefer not to answer. Gender Identity * Agender, genderqueer or Genderfluid Man Non-binary Questioning or Unsure Woman An Identity not listed here I prefer not to disclose We really want to know who our members are. Is there something you want us to know about how you identify? The work of NJ-AIMH is done in committees. Please read the attached descriptions and indicate which of the following committees you are interested in joining in 2025. * College/University Student Engagement Membership & Endorsement Public Awareness & Development Training & Reflective Supervision I prefer not to choose at this time. How did you first learn about NJ-AIMH? Via an email from NJ-AIMH At an exhibit table at an event Via a colleague If via a colleague, may we ask who?If via a colleague, may we ask who? OtherOther If you selected other, please let us know more. Thank you for completing this form. You will receive membership confirmation after payment is received. If you are human, leave this field blank. Δ
