APA Division 18
Membership Application Form

(please fill out and print)

 First Name                                       Last Name                                                     Middle Initial:
   

Mailing Address

City                                                                           State                                        Zip
      

Country                                                                    
      

E-Mail

Telephone                                                                                     Fax
      

Listserv:  Would you like to become a member of the Division 18 listserv?  Yes No

Education:   

(Highest Degree):   (Date of Degree):

Division membership status requested:  

      Member      Associate    Affiliate    Student

APA Member? :   Yes No   Membership  #:

Note:  Members and Associate (masters-level) members of Division 18 must be members of APA.  Affiliates are non-APA members who meet the requirements for APA membership.  To qualify for Student membership, you must be enrolled at least halftime in a psychology-related program of study.

Division 18 has five specialty sections, please check ONE you most prefer:

      Community and State Hospital
      Criminal Justice
      Psychologist in Indian Country
      Police and Public Safety
      Veterans Affairs

Become Involved in Division 18

Division 18 is entirely volunteer driven.  If you want to advance public service psychology, make Division 18 strong by volunteering a few hours of your time each month.  Please check the interest areas that apply to you, and you will receive additional information on which to base your decision.

      Bylaws, Policy and Procedure    
      Newsletter
      Membership
      Convention Program
      Web Site Development
      Advocacy
      Continuing Education
      Section Affairs
      Student Governance (students only)

Join Your Regional Psychological Association 

Regional legislators write most laws that govern the practice of psychology.  Join your state or provincial psychological association to help advance and protect the practice of psychology in the public sector.

      Please provide further information on my state or provincial psychological association.
      Please provide information on APA for non-APA members.

Membership Dues, Assessments, and Contributions

Members, Associates, Affiliates ($45) :        

Students ($25)                                         :        

                                                    TOTAL:         

Please print this form and return it completed with check, made payable to APA Division 18, to:

                Bill Safarjan, Ph.D.
                APA Division 18 Membership Chair
                5100 Cascabel Road
                Atascadero, CA  93422-2345
                USA

Revised 12/12/05