Member Benefits Become a Member Renew Your Membership			New Member Registration Form To become a member of NCSPP, simply complete the following form and click "Submit." You will then be taken to a screen where you can make an instant payment online, or get instructions for mailing in a check. Name Please indicate the professional listing you prefer (e.g., Joan Smith, Ph.D.). Address 1 Please include street, city, state, and zip code. Associated Phone Number: Include in member directory? SELECT ONE Yes No Address 2 Please include street, city, state, and zip code. Associated Phone Number: Include in member directory? SELECT ONE Yes No Your Email Address Please include, as we send many important announcements via email. Your Fax Number Your License (Type, Number, State) Number of Years Licensed APA Member SELECT ONE Yes No Division 39 Member SELECT ONE Yes No Graduate School and/or Other Affiliations How You Heard About NCSPP Membership Level Full members ($105): All licensed mental health professionals who have an interest in psychoanalysis and/or psychoanalytic psychotherapy. Member status does not, by itself, imply competence to practice psychoanalysis and/or psychotherapy. Associate Members ($50): Individuals, not currently students, who are not licensed in any of the mental health disciplines, or who are no longer practicing in any of the mental health disciplines, or who live out of state (and thus are unable to take advantage of our programs in person). Associate Members ($25): Individuals currently enrolled in an undergraduate or graduate school in a mental health discipline. Please fax (415.457.6276) or email a copy of current student ID. SELECT ONE Full Member ($105) Associate Member: non-student ($50) Associate Member: student ($25)
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