To Join Division 37 and/or the Section on Child Maltreatment," please print out this page, complete the following information and return to APA Division 37:

Membership Application: Division 37

Contact Information

Date: _________________

Name: _________________________________

Address: ______________________________________________

City: ________________________________________

State: ____________		Zip Code: ________-_______

Phone: 	(Office) ___________________  (Home) ___________________

Email: _________________________________________________________

Place of Employment: __________________________________

Job Title: ________________________________

Present Membership in APA (check one):

 ______Fellow	______Member	_____Associate	______Student
 ______Non-member

APA Membership #: ____________________


Membership Sought In:

Division 37 Only
_____Member ($35)          _____Affiliate ($35)         _____Student ($15)

Both Division 37 and the Section on Child Maltreatment
_____Member ($65)          _____Affiliate ($65)          _____Student ($35)

Section on Child Maltreatment Only
_____Member ($30)          _____Affiliate ($30)          _____Student ($20)      

Please make checks payable to Division 37-APA

Send Application and Membership Fee to:

Division 37 Administrative Office
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242