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MPAGS Application Form



About Graduate Student Membership

  • Students who are matriculated as psychology graduate students in a regionally accredited college or university, and interns or post-doctoral fellows may apply for Student Membership. (To ensure your eligibility for membership, it is suggested that graduate students enrolled in an online university program check with the status of your university's regional accreditation.)
  • Graduate student members of the Association shall be engaged primarily in the study of the scientific and professional discipline of psychology.
  • Graduate student members shall be enrolled in a graduate program that is primarily psychological in content.
  • Graduate student members do not have the right to vote and shall not hold elective office in MPA except as otherwise specified. A voting MPAGS representative is on the MPA Board of Directors.
  • Graduate student members of MPA are also members of the Maryland Psychological Association of Graduate Students (MPAGS). Student members pay significantly lower dues than MPA members.

Name:

Date of Birth:  

Present Degree: Other:

Training Status:
Graduate Student
Post Doc Fellow


Current Mailing Address

Street: 

City:     State:    Zip: 

County:  

Phone:  


Communication

My e-mail address for MPA business (newsletters, listservs and/or workshop confirmations) is:


Confirm email address:

I authorize MPA to send e-mails to me as necessary.

I would like to enroll in the MPA Member Listserv: an interactive e-mail communication list used by members to discuss pertinent information with colleagues, i.e., referral sources, ethical questions, practice information etc.

I would like to enroll in the MPANEWS: an e-mail announcement list to keep you informed of important issues related to MPA.

I would like to enroll in the MPAGS Listserv: an e-mail communication list used by graduate students to discuss and share pertinent school, psychology and career issues.



Education/Training Settings

Graduate College/University:  

Internship Location:  

Program:   Dates:

Degree/Major:

Facility/School Address:

City:     State:    Zip: 

Phone:  



Post Doc Fellows Only

If you have been awarded your doctoral degree and are currently doing a post doc to accrue supervised hours toward licensure you may join MPA at the student price.

Degree:

Degree year:

Degree from:

Post Doc location:

Location phone:

OR

I am seeking post doc training.



I am currently enrolled in the program indicated and I will adhere to the Ethical Principles of Psychologists and Code of Conduct of APA.


Signature   Today's date


Payment

MPAGS Dues: $40.00/year

Dues paid from 6/10/16 to 5/31/17 are for membership thru August 31, 2017


When entering your Credit Card information please include the billing address that matches your credit card billing address. Thank you!

Name On Card:

Credit Card Type:

Credit Card Number:

Expiration Date:

Billing Street Address:

Billing City:

Billing State:

Billing Zip:



(Your credit card information is being sent over a secure server.)



Once you submit your payment, you will receive an e-mail confirming that MPA has received your application.