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THE SOCIETY OF PEDIATRIC PSYCHOLOGY
DIVISION 54, AMERICAN PSYCHOLOGICAL ASSOCIATION
Online Membership Application
If you wish to pay by check or money order, please download the Membership Application Form by
Clicking Here
and follow the
instructions on the form.
Please provide the following user information
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Please provide the following contact information
First Name:
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You May include prefixes, titles, suffixes, or degrees.
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Cape Verde
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Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
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Cote D'Ivoire
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Djibouti
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Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
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Hungary
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Iraq
Ireland
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Italy
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Jersey
Jordan
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Kenya
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Korea, Republic of
Kuwait
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Latvia
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Liberia
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Liechtenstein
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Luxembourg
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Moldova, Republic of
Monaco
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Niue
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Northern Mariana Islands
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Oman
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Paraguay
Peru
Philippines
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Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
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Saint Lucia
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Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
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Serbia
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Sierra Leone
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Slovenia
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Spain
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Sudan
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Switzerland
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Virgin Islands, U.S.
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State or Province:
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AA - Armed Forces Americas
AE - Armed Forces Europe
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AP - Armed Forces Pacific
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Guamanian or Chamorro
Samoan
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Other Race:
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Please check all that apply:
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Are there languages besides English that you use in your professional work?:
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Other languages:
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French and French Creole
Other
Language:
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MA
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Are you willing to mentor a student via our Mentorship Program? :
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No
Licensed:
Yes
No
Private Practice:
Yes
No
Areas of Interest - Please select up to 6 areas of interest.
Area of interest:
Adherence
Developmental Perspectives
Neonatology
ADHD
Diabetes
Neurological Disorders
Adolescents and Young Adults
Differences of Sex Development
Neuropsychology
Allergic Diseases
Digital Health
Obesity
Autism Spectrum
Drug Abuse and Exposure
Orofacial and Dental
Behavior Problems
Eating and Feeding Disorders
Pain
Bereavement, Death, Dying
Elimination Disorders
Palliative Care/End-Of-Life
Biofeedback and Relaxation
Endocrinology
Parenting and Family
Burns
Epilepsy
Peer Influences
Cancer and Oncology
Evidence-Based Practice
Primary Care
Cardiology
Family
Pulmonary
Child Abuse and Neglect
Gastroenterology
Rehabilitation
Complementary and Integrative Medicine
Headache
Renal and Urology
Consultation-Liaison
Health Disparities/Multicultural Issues
Rhematology
Coping Skills and Adjustment
Health Policy and Public Health
Sleep Disorders
Craniofacial
Health Promotion and Prevention
Social Skills and Development
Crime and Violence
Hematology
Stress and Anxiety
Cystic Fibrosis
HIV/AIDS
Transplant Services
Deafness and Hearing Loss
Injuries
Traumatic Brain Injury
Developmental Disabilities
Medical Traumatic Stress
Please provide the following membership information
Membership Category:
--
APA Member, not APA Student Affiliate Member - $55.00
Psychologist, not a member of APA - $55.00
Allied Professional at or below the doctoral level - $55.00
Physician - $55.00
Postdoctoral Fellow - $20.00
Graduate Student - $20.00
Undergraduate Student - $20.00
Intern - $20.00
Retired - $55.00
Free membership - $0.00
Directory Only - $0.00
APA Membership Number:
How did you hear about us:
--
Mentor
Website
Newsletter
Journal
Peer
Department or University
Conference
American Psychological Association
Other
Referred By:
Please provide billing & payment information
Same as Above
First Name:
Last Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
Country:
--
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
State or Province:
--
AA - Armed Forces Americas
AE - Armed Forces Europe
Alabama
Alaska
Alberta
American Samoa
AP - Armed Forces Pacific
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Marianas Islands
Northwest Territories
Nova Scotia
Nunavut
Ohio
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Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
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