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. New and renewal memberships for 2025 expire on 12/31/25. 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
