Membership New AP Membership Membership Type * Full $150 Graduate Student $75 Retiree $75 Total Amount Your Information First Name * Last Name * Email * Phone Licensure Category * PsychologistPsychiatristPsychiatric Nurse PractitionerLicensed Professional CounselorMarriage/Family TherapistSocial WorkerNon-licensed Licensure(s) CGP DO LCDC LCSW LMFT LMHC LPC MD MFT MSW NCC PhD PsyD LCSW-S LPCC LMSW LICSW LP Professional Website Street Address * City * Postal Code * Country * - select Country - United States State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Membership Details Membership Directory I would like to be listed in the directoryDO NOT list me in the directoryI would like to be listed, but do not want my address included What age groups do you primarily work with? Child Adolescent Adult Senior What are the modalities of your practice? Individual Therapy Psychoanalysis Couples Therapy Family Therapy Group Therapy Case Consultation Clinical Supervision Medication Management Are you a member of Division 39 of the American Psychological Association * NoYes Do you list Austin Psychoanalytic as your primary affiliation with Division 39? * NoYes Are you interested in volunteering to serve in one of the following areas? Membership and recruitmentSocial media and marketingSocial EventsPresidentTreasurerSecretaryAPA CouncilorPresentation ProgrammingScholarship Committee Payment Options Payment Method Credit Card Pay by check Submit Membership
