[ Home ]    

View this page in: [ Français | Deutsch | Italiano | Português | Español ]

Registration Form

While Basic Membership is free, we will only include organizations, businesses, or agencies where the name of an individual has been included.  The object of this is to allow clients to choose specific people to work with.  If you want your business, with all of your professionals listed, then consider the Enhanced or Custom membership.  
[FrontPage Save Results Component]

Basic Membership Entry Form

Personal Information
Please fill out the form completely.

An important point to remember: How you fill this out will be exactly how it shows to the public.  So, please use proper capitalization & punctuation.

Please select one:

Basic Membership Entry Form (Free, limited entry) [To add link to already existing website - $65 annually- Add link]
Enhanced Membership Entry Form (Web page+e-mail listing+services)  $195/annually ($16.20 monthly)
Custom Membership Entry Form (3 Web Pages+e-mail listing+services) $450/annually ($37.50 monthly)


Payment Options

        


 view samples

NEW
UPDATE (ALL data must be re-entered.)
First Name:

Middle Name:
Last Name:
Credentials:
Other Credentials (not included above): (Do not enter more than 6 characters.)

Specialty Directory: We offer listing in the following specialty fields.  If you choose one, you will be listed there as well as in the FindingStone Find-A-Therapist Directory without reference to this specialty.

  If you chose Minority  

If you scope of competence does not  fall in any of these specialties, please do not indicate them.  We want to be sure that we are representing you faithfully to clients.

If you do chose Minority, please check on of the following:

African American

Hispanic

Latino

Asian American

Native American

Other:

2nd Language:

Service Description:
(Enter a brief, 3 line description of your services. 
This data will be edited at our discretion.)

Primary Modalities:

Modality 1

Modality 2

Modality 3

Modality 4

Modality 5

Office Information

Company Name:
(if other than your own name)

Address:

City:
State/Province:

 If you a registering in CA, indicate the following:

Northern California
Southern California

State/County outside of US/Canada:

Postal Code:
(U.S. Residents will not be added if this is missing.)

Country:

Please use this format, when possible:
"Country Code" "(City/Area Code)" 000-0000

Telephones
Voice:
FAX:
Email Address:
Your e-mail will not be listed.
E-mail address is required.
Re-Enter Your E-Mail Address:
Double-check the accuracy of your e-mail address.

License Number:
Web site (if any):
Touch this Submit Button ONLY once.

Please be patient with the Submit button.  If you hit it more than once, you'll leave multiple submissions.

For information and quotes on your personal domain (www.yourbusinessname.com)  hit the "send information" button and a representative will contact you by e-mail.

 [ Home ]