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Indiana AFCC Membership Database Submission

Indiana AFCC Membership Information Update

Please use this form to submit your information to be listed in our membership database or to update your existing information.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Form Submission Type*

Is this a new submission or are you wanting to update your existing information found in our database?

New

Update

Years of AFCC Membership*

How many years have you been a member of the Indiana AFCC?

1 year

2 years

3 years

4 years

5 years

Over 5 Years

Years of Extended AFCC Membership

In the field below, please enter in numeric format the number of years you've been an AFCC member.

Name*

Prefix First Middle Last Suffix

Profession / Practice Area*

Please check which of the following services apply to you specifically. [Check All That Apply]

Attorney

Arbitration

Brief-Focused Assessments

Child Informed Mediation

Counselor

Co-Parenting Therapy

Custody Evaluator

Functional Family Therapist

Guardian Ad Litem

Home Based Therapist

Judicial Officer

Parenting Coordinator

Psychologist

Psychiatrist

Registered Domestic Relations Mediator

Reunification Therapist

Social Worker

Organization / Company Name*

Business Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Website

Alternate / Personal Email

Social Media Accounts

Are you active or have a profile on any social media accounts? Please let us know so we can connect with you through social media as well!
Just enter the platform name (i.e., "Twitter" in the 1st column and your profile username or link (i.e., @Indiana_AFCC) in the 2nd column.

Platform

Profile URL

Headshot Photo

Please upload a quality headshot photo image we can use for the directory. Files should be uploaded in .jpg format and not exceed 200MB in file size.

Accepted file types: jpg, Max. file size: 250 MB.

Notes

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Save the Date

AFCC Indiana 2026 Annual Conference
Friday, Oct. 23, 2026
”The ABCs of PCCPs: Parent-child Contact Problems and Potential Solutions.”
The Founders Lodge Event and Conference Center
Indianapolis, IN

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