APS New Membership Form

Printable New Membership Form

* All Bolded fields are required.
Member Information
If you are currently or ever have been an APS Member, please Login to retrieve your current contact information and renew your membership. You can use the "Forgot Your Member ID" link on the Login page if you do not know your member ID.
Prefix: (Example: Dr, Mr, Ms, Mrs, Miss, or military rank)
*First Name:
Middle Initial:
*Last Name (Surname):
Suffix: (Example: Sr, Jr, III, IV)
Title:
*Affiliation:


Contact Information
* Address Type:
*Street Address:
 
*City:
US State:
Zip/Postal Code:
Non-US State/Province:
*Country:
Office Telephone: (Example: 555-123-4567 x890)
Home Telephone:
Fax Number:
*Email Address:
Personal Web Site:
(Example: http://www.mysite.edu/dept/mypage.html)


Demographic Information
* Major Field:
Please select one or more major fields of study. You may rank your selections using the "Up" or "Down" buttons
Specialty Area(s): (i.e., Autism, Language and Memory, Consumer Psychology, etc)
Degree Institution:
*Highest Degree Completed: *Year Awarded:
Expected Degree (for students): Year Expected:
Gender:
Date of Birth: (Example: mm/dd/yyyy)
(For APS use only: will not be published or released)
Employment Sector:
Race/Ethnicity:
Please select one or more Race/Ethnicity choices.


Promotional Code
If you are taking advantage of a special promotion, please enter your code below:
Promotional Code: