| THERAPIST LISTING FORM
- Print and Mail
Members of SAFOJ who are also professionals in the mental health arena
are eligible to be listed on our web site at www.safoj.org. This is a free
service offered only to our members, our way of promoting professionals
who support Jungian psychology. If you care to take advantage of this members-only
offer, print the form below and fill in the desired information (please
print) and mail to SAFOJ, P O Box 64267, Tucson, AZ 85728-4267. If
you include your e-mail address below, we will notify you by that means
when your listing is published. If you have questions, call us at (520)
327-3485.
Your name and title as you want it listed: _____________________________________________________________________
Name of business (if different):
_____________________________________________________________________
Business location:
_____________________________________________________________________
Mailing address (if different):
_____________________________________________________________________
Business telephone:
_____________________________________________________________________
E-mail address:
_____________________________________________________________________
Type of business:
_____________________________________________________________________
Specialties, specific areas of expertise:
_____________________________________________________________________
_____________________________________________________________________
Your credentials and/or education:
_____________________________________________________________________
_____________________________________________________________________
Any other description or elaboration about your business you want listed:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Signature
_____________________________________________________________________
Date
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