Membership Form

Personal Details

MEMBERSHIP CATEGORY APPLYING FOR

Full Member - $4000

Affiliate Member - $2500

International Affiliate (M) Member - $30USD

International Affiliate (B) Member- $20USD

Student Member - $1000

Mailing Details

Country

Contact Details

Mobile#

Work#

Highest Psychology Degree Attained

Highest Psychology Degree - Title of Degree

Date Started

Date Ended

Name of Institution

Faculty & Department

City

Highest Psychology Degree - Country

Current Level of Study (If Applicable)

Current Level of Study - Title of Degree

Date Started

Date Ended

Name of Institution

Faculty & Department

City

Current Level of Study - Country

Certification & Licensure

Are you certified or licenced by a profession psychology board or organization

Yes

Country

Expiration Date

Has your license ever been suspended or revoked by a regulatory body?

Yes

If Yes Please Give Date

Name of Regulatory that suspended or revoked license

Reason(s) for suspension/revocation

Have you ever been convicted of a crime in Jamaica or any other country?

Yes

If yes, please provide details concerning the nature of the offense and the action taken by the court in response to this offense.

Area of specialization and interest - Details

Checklist of Documents Enclosed

Diploma(s) - certified by Justice of the Peace/Notary Public

Maximum file size: 15MB

Valid proof of enrollment – picture of student ID or acceptance letter (required for student applicants ONLY)

Maximum file size: 15MB

Resume (listing all specialized training & membership in organizations)

Maximum file size: 15MB

If you are human, leave this field blank.

* Please note that all degrees must be signed by a justice of peace or notary public for it to be considered.

Personal Details

Mailing Details

Contact Details

Highest Psychology Degree Attained

Current Level of Study (If Applicable)

Certification & Licensure

Checklist of Documents Enclosed

Useful Links

Contact Us