CHicago Chapter Association of Psychological Type

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CHAPT Membership Profile

Please complete if you are joining CHAPT, renewing your membership or updating your profile. Please review, correct or supply missing information and help us keep our membership database up-to-date. Thank you

Age Group  

 < 21 21 to 30 31 to 45 46 to 65 > 66  

 Preferred Salutation  

 Dr. Mr. Mrs. Ms. Rev.

First Name  

Last Name  

Home Address  

City  

 State  

 Zip  

Home Phone  

Home Fax  

Home Email  

Send Mailings To  

 Business Home  

Company  

 Company Address  

City  

 State  

 Zip  

Company Phone  

Company Fax  

Company Email  

 Company Website  

Job Title  

MBTI Type Have you taken the qualifying course on the MBTI? Yes No  
Are you a member of the Association of Psychological Type? Yes No  
How would you rate your understanding of psychological type? Beginner Intermediate Advanced  

  Directory

Check all that apply.

  Yes No   Do include me  

Please verify your wishes to be included in the Membership Directory, which address you wish to have listed with your name, and which interest areas (whether interest or referral status) you want published.

  Yes No   Include home address  

  Yes No   Include business address    

  Yes No   Include interests  

  Yes No   Include referrals  

Interest Areas Please update your areas of interest/referral. Your Referrals (listed on the left) mean you provide these types of services and would accept inquiries. Your Interests (listed on the right) mean you would like to learn more about it, but do not provide services.

  My Referral Areas     Areas     My Interest Areas  
  Counseling: Individual  
  Counseling: Careers  
  Counseling: Couples  
  Counseling: Family  
  Self Understanding  
  Management/OD  
  Team building 
  Religious/spiritual  
  Education  
  Research  

CHAPT Membership Profile-2006 Renewal

Volunteer Please update or confirm the areas where you are interested in helping CHAPT.

  Master List     My Current List  
  Meeting: Greeter  
  Meeting: Handouts/Evaluation  
  Meeting: Photos  
  Meeting: Recording  
  Meeting: Refreshments  
  Meeting: Signs  
  Newsletter: Editor  
  Newsletter: Contributor  
  Program: Planning  
  Program: Speaker  
  Recruiter: phone caller  

If you volunteered to be a speaker at a meeting, what topics would you be able to present?

What three meeting topics would you most like to see at next year's meetings?
(This year's meetings are already planned!)

Password:
(This will allow you to come back and change this information and help you register for meetings.)