Name: WVPA Membership Registration
SKU: 39
Availability: InStock

License #

APA Member

Yes
No

Graduate School (completed degrees only)

Graduation Date (completed degrees only)

For students only: Current graduate school

For students only: Anticipated graduation date

Ethics Declaration*

Agree
Disagree

I agree to abide by the Ethical Principles of Psychologists and Code of Conduct set forth by the American Psychological Association

Please confirm:*

Have you at any time been convicted of a felony, sanctioned by any professional ethics body, licensing board, or other regulatory body or by any professional or scientific organization?

No
Yes

If Yes, please explain:

WVPA referral service participation

I agree to participate
I do not want to participate

Ethnicity

I was a previous member of WVPA?

No
Yes

Languages

Areas of Practice (Please only select areas of practice you are currently competent to assess for/treat rather than selecting all areas of interest.)

Ages Served

Infants / Toddlers (0-3)
Children (3-12)
Adolescents (13-17)
Adults
Geriatric

What advocacy issues are important to you?

What type of CE events/topics would you like to see?

What do you value most about WVPA membership?

What opportunities/experiences would you like to see in WVPA?

More Information

Education / Experience

Social / Volunteer Organizations

Registration Total:

$0.00

Time

:

Registration Checkout

WVPA Membership Registration

Step 1 of 3

Welcome to the WV Psychological Association

Registration Checkout

WVPA Membership Registration

Step 1 of 3

Welcome to the WV Psychological Association

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