Join Now

MLPCA is a professional organization for licensed professional counselors and mental health counselors in Mississippi.

Please complete this form to join our team. You will be taken to PayPal after submitting this form to complete the secure payment. Please contact today with any quesitons.

Membership Options *

Name *

First

Last

E-mail *

Cell Phone

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Comment or Message

Name *

First

Last

By submitting this form via this web portal, you acknowledge and accept that risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Yes, I want to submit this form

Comment