Austin Psychoanalytic Membership

Are you a member of Division 39 of the American Psychological Association
Do you list Austin Psychoanalytic as your primary affiliation with Division 39?
Address (as you want it to appear in the Membership Directory)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (as you want it to appear in the Membership Directory)

Area CodePhone Number
Alternate Phone Number (Will not appear in Membership Directory)

Area CodePhone Number
Professional website
Our online Membership Directory listing all members who want to be listed will include name, address, phone number, e-mail address, website, population served, and areas of specialization.
Population(s) Served: Check all that apply
Specialty Areas: (Please list)
Volunteering
Check below if you are interested in volunteering to serve in one of the following areas:

Other
Payment

Memberships will auto-renew annually until you notify Austin Psychoanalytic (info@austinpsychoanalytic.org) to stop payment. If paying by check, please complete the form online and indicate you are sending a check. Please have check made out to Austin Psychoanalytic and mail to P.O. Box 162082, Austin, TX 78716.
Payment Options

Annual Full Member($150.00 for each year)

Student Member/Retiree($75.00 for each year)

Volunteering