(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 ($49) :
Students ($25) :
TOTAL:
Please print this form and return it completed with check, made payable to APA Division 18, to:
Bret A, Moore 9597 Jones Road #218
Houston, TX 77065
Revised 8/14//07