Home About Us Marriage Centers Affiliate Program Parenting Center Locate Educator/Affiliate Fees & Services Media/PSA/TV Ads Events Calendar Donations

 

Affiliate Application
Affiliate Program

Become an Instructor
How to Qualify
Affiliate Application
On-Line Educator Training
Payment Information
Programs
Fees & Services
Affiliate Login
Contact_us

Untitled Document

National Marriage Centers Affiliate Application

To qualify as an affiliate member you must complete each of the following steps:

  1. Fill in all required information in the Form below.
  2. Indicate which method you have chosen as your training to meet the qualification requirement.
  3. Certify that you have read the terms of our agreement.
  4. Proceed to Payment.

During the registration process, you will be asked to provide your billing information.    Please note that your Credit Card or Checking Account will not be billed during your free trial period and you can cancel at any time. Once your free trial period has expired, National Marriage Centers will automatically bill your Credit Card or Checking Account $20.00 each month

 

Title :
FirstName :
LastName :
Address :
City :
State :
Zip :
Country :
Phone :
Cell Phone :
Email :
   
OrgName :
Org URL :
   
Date of Birth:
(optional)

 

Personal Profile Statement ( 80 words or less )
Describe your Training - in Marriage and Relationship Education, Coaching, Mental Health Professional, List Courses, Certificates or Degrees, Organizational Association. Languages spoken other than English.

 

Description of Services and Client Specialization:
(check all that apply)

8-Hour Relationship Classes   
Private Education and Coaching Sessions
Faith Based Program
Couples
Individuals
Families
Groups
Phone Sessions
Primarily Females
Primarily Males
Parenting
Divorce Mediation
Alternative Relations
African Americans
Hispanics
Asians
Mexican American
White/Caucasian
Native Americans
Native Alaskan
Native Hawaiian
Other
 
 
 
Training Method:   Program:
 
Password :  Provided upon payment

 

Terms of Agreement

I certify that the above information is true and correct and I am not misleading or providing false information to the National Marriage Centers or National PreMarital Institute. I understand that I may be asked to provide additional documentation. Misrepresentation of my profile, the refusal to provide documentation at a later time if asked, allowing my affiliation in the National Marriage Centers and National PreMarital Institute programs to lapse or the non-compliance with the Code Of Ethchs or the Licensing Agreement, will result in the revocation of my Affiliate status and my association termination. I agree to hold harmless and indemnify NMC, NPMI and its officers, directors, employees and agents for any misrepresentations of my profile and for all claims, loss, damage, judgment or expense. The National Marriage Centers and National PreMarital Institute does not endorse, guarantee or warrant the work or opinions of any individual affiliate. Member affiliation does not imply licensing by this organization of an affiliates, qualifications, abilities or expertise. Affiliates that do not possess a governmental professional license, if it is required within the state they provide their services, are not permitted to represent themselves as a psychologist, psychiatrist, psychotherapist, certified social worker, counselor or other titles and terms restricted by their jurisdiction. The views expressed by the affiliates as author, publisher or presenter are their own and do not necessarily reflect those of  NMC, and NPMI. The National Marriage Centers and National PreMarital Institute does not assume any responsibility or liability for its affiliate members or subscriber’s efforts to apply or utilize the information, suggestions or recommendations made by this organization, it’s publication, resources or activities.

 

I certify that I have read the above statement and agree to all of its terms

 

NOTE: If you would like to cancel your membership during your free trial period, call 516-909-1200

Prices are subject to change without notice. You may also mail or fax this application form and payment to the address listed in our Contact Us page. Make checks or money orders payable to: NPMI. There is a $30.00 service charge on all returned checks. Payments are in U.S. funds drawn on U.S. banks only.

 

 

After completing this form you will be notified by e-mail with your affiliate Log in ID to access the restricts areas of our site.