Mid-Atlantic Biofeedback Society

MABS Membership Form

To join MABS, simply fill out this form, press submit, and make a payment. Data submitted is listed in the MABS Providers List unless otherwise specified in your submission.

You may also print a membership form and mail the form and payment to:

The Mid-Atlantic Biofeedback Society
c/o Bea Haskins, Executive Director
217 E. Middle St.
Hanover, PA 17331

Included in Providers List*
- Yes
- No
Membership - Check One*
- Renewal
- New
Membership Level*
Name (First, Last)*
Credentials*
Business Name*
Business Address*
Street Address City State ZIP Code
Phone*
Email*
Website
The following information is for our records and will not appear in your listing on the website:
Mailing Address (if different form above)
Street Address City State ZIP Code
Current Licensure (type and state)*
Current Certification (if BCIA, please provide your certification #)
Interventions Employed (check all that apply)
- Biofeedback
- Neurofeedback
- Other
Other