1.   Please copy and paste this form into an email.

2.  Fill in the information requested.  

3.  Send your membership email to membership@amppa.org. 

Thanks!

Full Name:

Mailing Address:

City, State, and Zip:

Email:

Web (if any): 

Phone: 

Practice or Business Name (if applicable):

Occupation: 

Degrees, Certificates, Designations, Diplomas, Seminars, Programs Completed:  

Have you read any books or completed any courses or programs in positive psychology?  If so, please list:

Why are you interested in joining and being a member of our association?  

What is it about positive psychology that interests you?  

The annual membership fee is $98. 

Please provide the below information for payment:

Name on Card:

Address on Card: 

City, State, and Zip for Card: 

Card Number:

Expiration Date:

Security Code: 

I authorize payment of the annual membership fee of $98.  

___________________________________________________

Type your name as your electronic signature

Date: