Verified Membership Registration

We are honored by your interest in becoming part of Emerald Book.

Every application is carefully reviewed to ensure that our members meet professional standards and represent excellence in their fields. If accepted, your application fee will be applied directly toward your annual membership dues. Please note that application fees are non-refundable.

For questions about the process, contact us anytime at support@emeraldbook.org .

For Business Memberships, click here.

The more complete your profile, the higher your trust rating and visibility on Emerald Book will be. Thank you for helping build a trusted network!

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First Name *

Last Name *

Display Name

Professional Title *

Doctorate Degrees Earned *

Specialty / Field of Practice *

Insurance Accepted * Enter N/A if not applicable.

Do you self-identify as Black or of African Descent? *

Username *

Email *

Confirm Email *

Password *

Confirm Password *

Website URL

Office Details

Place of Work / Business Name *

Address 1 *

Address 2

Office Phone *

Office Hours

Please enter your regular office or business hours during which you are available to see clients or patients.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Verification Details

Professional Credentials Verification *

Drop your file here or click here to upload You can upload up to 1 files

Please upload a picture or scanned copy of your degree or title earned.

Licensing Board or Authority Verification

Drop your file here or click here to upload You can upload up to 1 files

Please upload a scanned copy of your licenses or certifications (e.g., State Medical Board, State Bar Association, State Board of Psychology).

License or Registration Number *

Jurisdiction of License State, province, or country where the license is valid.

License Status

License Expiry Date

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Confirm Annual Membership Dues *

Verified Member - USD $30

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Payment Method *

Policy Agreement *

I agree to the Term of Service and Privacy Policy.

By registering, you agree to the Terms of Service & Privacy Policy of Emerald Book, Inc.

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