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* Required Field
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* Member Type (indicate):
Life ($500)
Professional (Ph.D., Masters, or equivalent $50)
Retired (over 65 No fee)
Student (graduate or undergraduate $15)
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*Highest
Degree/Year:
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*Name:
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*School & Program Attended/Additional Degree/Certification:
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*Position Title:
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Office Address:
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Office Phone:
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*Email:
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*Home Address:
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*Home Phone:
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*Mobile Phone
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Website:
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Practice & Consulting Database:
Would you like to be in the local NYABPsi practice & consulting referral database?
$25 additional fee. Place an X in the appropriate box below
(Only your name, preferred address and specialty will be published in the referral directory).
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YES
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NO
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Private Practice/Consulting Name:
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Preferred Address (check one):
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State License(s):
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Office
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Practice/Consulting Speciality Description
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Home
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No Address
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Committees of Interest (check all that apply):
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Serve If Available, As Needed – Willing to assist with NYABPsi initiatives if
available, as needed. You will be contacted.
Membership – Implements membership strategic plan and activities
Communications – Develops public relations programs and maintains media
outlets.
Student Circle – Develops programs to foster student development
Programs Planning and Development – Carries out programs of the Association
Professional Affairs, Development & Training – Conducts associated projects
Legislative & Social Action – studies civic and legislative influence in the
community & collaborates with other Black organizations, groups, and persons.
Fundraising – Plans and implements enjoyable fund raising activities
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Sponsorship:
To foster support and connection in the psychological community, new members are
required to have a sponsor. A sponsor is a current member willing to be an informal
resource for introducing new members to the organization.
If you do not have one and need a sponsor please call 212-802-5480. Call now.
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*Sponsor's Name:
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*National Membership (required)
Are you a member of ABPsi national office? (please check one)
If no, please go to www.abpsi.org for an application.
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NO
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YES
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Click icon to "submit" application after you
Make Payment
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