MEMBERSHIP Membership Application Membership Directory Membership Information Brochure MEMBERS ONLY Update Membership Directory Subscribe to Listservs Register for Member's Login CE Course with PsyBC GRADUATE STUDENT COMMITTEE More Info COMMITTEES More Info CONTINUING EDUCATION More Info CONFERENCES 2010 Chicago Spring Mtg PUBLICATIONS Newsletters Archives Journal Book Reviews Spotlight ONLINE RESOURCES More Info DIVISION 39 SECTIONS I. Psychologist-Psychoanalyst Practitioners II. Childhood and Adolescence III. Women, Gender, and Psychoanalysis IV. Local Chapters V. Psychologist Psychoanalyst Clinicians VI. Psychoanalytic Research Society VII. Psychoanalysis and Groups VIII. Couple and Family Therapy and Psychoanalysis IX. Psychoanalysis and Social Responsibility

Membership Membership Application You can fill out the membership application and submit it online. If you prefer not to use the online option, please enter the requested information, print, and mail it in with a check or money order in order for your membership to be activitated. Division of Psychoanalysis 2615 Amesbury Road Winston Salem, NC 27103 Phone: 336-768-1113 Fax: 336-768-4445 Last Name* First Name* Highest Degree Year degree received: Primary Address* (line 2) City* State* --\nAK\nAL\nAR\nAZ\nCA\nCO\nCT\nDC\nDE\nFL\nGA\nHI\nIA\nID\nIL\nIN\nKS\nKY\nLA\nMA\nMD\nME\nMI\nMN\nMO\nMS\nMT\nNE\nNC\nND\nNH\nNJ\nNM\nNV\nNY\nOH\nOK\nOR\nPA\nRI\nSC\nSD\nTN\nTX\nUT\nVA\nVT\nWA\nWI\nWV\nWY\nPR\nON\nQC\nBC\n Zip* Telephone Fax Email* Foreign Language Fluency States Licensed In --  AK  AL  AR  AZ  CA  CO   CT  DC  DE  FL  GA  HI  IA   ID  IL  IN  KS  KY  LA  MA   MD  ME  MI  MN  MO  MS  MT   NE  NC  ND  NH  NJ  NM  NV   NY  OH  OK  OR  PA  RI  SC   SD  TN  TX  UT  VA  VT  WA   WI  WV  WY  PR  ON  QC  BC   For Member's Only features Type a Password* Retype Password* MEMBERSHIP CATEGORIES*: Member ($95.00) Psychologists who are Fellows, Members or Associates of the APA are eligible to become Members of Division 39, as are doctoral level licensed psychologists who are ineligible to join the APA due to APA restrictions on program accreditation. Non-psychologist holders of graduate degrees who are licensed or certified in a mental health discipline are also eligible to become Members of Division 39. Affiliate ($95.00) International members of the APA and psychologists who do not belong to APA are eligible to become Affiliate Members of Division 39. Other individuals who have demonstrated an interest in psychoanalysis through academic training, institute training, continuing education, writing or related study are also eligible to become Affiliate Members. Student ($25.00) Undergraduate and graduate students interested in psychoanalysis are eligible to become Student members of Division 39. PLEASE CHECK ONE: $95.00 Member - APA # $95.00 Member (other mental health professional) $95.00 Affiliate $25.00 Student IMPORTANT: Unless declined below, your contact information will be published in the Division 39 electronic directory. NO, do not publish my information in the Division 39 electronic directory. © Division of Psychoanalysis, 1999-2003