To join NJ-ACT, you must be licensed for independent practice in New Jersey; hold a permit to practice psychology in New Jersey; or be licensed for independent practice in another state and live in New Jersey.
New members must mail or email a membership application. You may pay online or mail in your check.
Recurring Payment Option
One-Time Payment Options
I am licensed for independent practice in New Jersey or I hold a permit to practice psychology in New Jersey or I am a NJ resident, licensed in another state.
_____ I have paid online
_____$80 is enclosed for a NJ-ACT membership through April 30, 2019.
_____$40 is enclosed for a NJ-ACT membership through April 30, 2018.
Name and Degree ________________________________________
Office County ____________________________________________
Permitted or Licensed As: __________________________
License/Permit Number ____________________________
Primary Office Address:
Primary Town ___________________________________ State ____ Zip ________
Primary Phone (____)_________________ Email* _______________@__________
Secondary Office Address:
Secondary Town ________________________________ State ____ Zip ________
Secondary Phone (____)_________________
Secondary Office County ______________
*We must have your e-mail address to send you our PDF directory, summaries of research studies, member discussions, and notices of opening and closing dates for workshop registration.
Do you want your private practice(s) to be listed on our website Member Directory? (members licensed for independent practice only, please check one)
____ Yes, a complete listing – street address, town, and telephone number.
____ Yes, a partial listing – town and telephone number, without street address.
____ No website listing, please.
To be listed in our website member directory sign and mail or email the following statement:
“I affirm that my profession’s licensing board permits me to practice independently and without restriction, and there is no complaint against me pending with my licensing board. I also agree to inform NJ-ACT immediately if any of these stipulations change.”