Collective Member Application Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Areas of PracticeCredentialsEducational BackgroundSpecialties or Areas of ExpertiseYears of Experience in your FieldWhat level of partnership are you interested in?CreatorAffiliateEducatorExpertPartnerIf applicable, what is your understanding of mental health issues?If applicable, what courses or webinars are you interested in facilitating?If applicable, what are your proposed content topics or ideas?Terms of Use *I UnderstandBy submitting this form via web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted electronic messaging and wish to continue despite those risks. By clicking "I Understand" you agree to hold The Academy of Integrated Mental Health and their website developers harmless for unauthorized use, disclosure, or access of your information sent via this electronic means.Submit