APA International Affiliate Application

International Affiliate Application

Please read International Affiliate Application Instructions before completing this application.

Applicant Information

(*Required field)

Prefix	First*	Middle	Last*	Suffix

Name: *

Country:*

Address: *

City:*

State/Province:

Zip/Postal Code:

Email:*

Please reenter Email for verification:*

Gender:*

Male Female Transgender

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:

Name(s) of national and/or international psychological association(s) of which you are a member:

Education:* (Give highest degree, major field of study, date of degree and institution)
Highest Degree in Psychology	Major Field of Study	Date of Degree (MM/DD/YYYY)	Institution

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.

International Affiliate Fee

Affiliate Fee	$27.00
Affiliate Fee - Developing countries or transitional economies	$20.00

I understand the affiliate fee is required whether or not I order journals.

Indicate your agreement:* Yes No