Community College Teacher Affiliate Application

Please read Community College Teacher Affiliate Application Instructions before completing this application.

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Applicant Information
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Name of School:*
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We require either a work phone number or a home phone number to facilitate follow-up:*
e.g., (123) 123-4567 or +1 123 456 4567
 Work Phone:   Ext:       Home Phone:            Fax:
Your affiliation with APA is considered part of the public record. Your contact information will be listed in the APA Membership Directory. If you wish to publish only your name in the directory, please check here.
 
Community College Teacher Affiliate Fee
Affiliate Fee $50.00
 
I understand the affiliate fee is required whether or not I order journals.

Indicate your agreement:* Yes    No