Joining the Affiliate Program

Annual Membership Fee: $1000
Annual Group Membership—3-5 Associates $2500

I would like to become an Affiliate Member of The Center for Transformational Psychotherapy. I am in agreement with the CTP Mission Statement and will conduct my ketamine practice within that framework. Please include me on the CTP Practitioner Referral List. My fee has been paid.

Name*
First Last
Office Address*
Street Address Address Line 2 City State ZIP Code
Office Telephone*
Office Fax
Office Email*
Website
Personal Contact info (for CTP use only)

Joining the Affiliate Program

Annual Membership Fee: $1000 Annual Group Membership—3-5 Associates $2500

Annual Membership Fee: $1000
Annual Group Membership—3-5 Associates $2500