Please fill out this information to apply online for AAMH membership or to update your membership information. Use the same form to apply for our Clinical Training Program.

The first set of questions is common to all applications and must be completed except for Membership Updates which require Name, Office Address, Office Phone Number and any change to be made for the record.

These items will be included on the Members’ Locator page of the AAMH Internet site once membership has been granted: Name, Business Name, Office Address, Office Telephone and Type of Practice. These are optional at your request: Business Web Site, Fax and E-Mail.

All other information will be held confidential and will not be published on this site, nor will the information gathered be made public.

To apply for Clinical or Associate Membership, you must complete the entire application and mail a photo copy of your degree and/or state license certificate to the address below. PLEASE NOTE: It is also acceptable for Associate Membership applicants to take a picture or scan of their license and degree and email it in to info@aamh.com. It will be joined with your application.

AAMH (American Academy of Medical Hypnoanalysts)
Attn: Membership Dept.
P.O. Box 365
Winfield, IL 6019-0365

Annual dues for Associate Membership is $135.00
Annual dues for Clinical Membership is $185.00

To pay dues by check, please mail to the above address and payable to: AAMH
To pay dues by phone, please call at 888-454-9766.
To pay dues online, please visit our online store.

NOTE: The fee for the Clinical Training Program can be paid at time of application acceptance.


Your Email (required)

Type of Membership (required)

Title

Your Name (required)

Date of Birth (required)

Type of Practice

Professional License, State, Number (required)

Degree (required)


Office Information

Business Name

Office Address 1 (required)

Office Address 2

City (required)

State (required)

ZIP (required)

Office Phone (required)
(999-999-9999)

Office Fax
(999-999-9999)


Home Information

Home Address 1

Home Address 2

City

State

ZIP

Home Phone
(999-999-9999)

Your name typed here signifies
all data given is true and correct: (required)