Membership Application

This form will take approximately 5-10 minutes to complete

Please have the following documents/information readily available:

Info item one
Info item two
Info item three

Application Number: 123456

= Required = Optional

I am a physician who has completed acceptable psychiatry training (as approved by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education, the Royal College of Physicians and Surgeons (Canada) or the American Osteopathic Association) and I have a valid license to practice medicine or I have an academic, research or governmental position that does not require licensure

I agree to the above statement

Your District Branch/State Assn.

The Branch or State Association you would like to apply through. More info

Are you a former member of the APA?

No Yes

Former APA name

APA Promo Code

Biographical Information

First Name

Middle Name

Last Name

Suffix

Date of Birth - DD/MM/YYYY

Country of Birth

Degree(s) - M.D, Ph.D, MPH

Non-English Languages Spoken

Contact Information

The following contact information is

Home Office

Street Address

Apt/Suite/Building #

City

State

Zip/Postal Code

Country

Phone

Fax

Add second Phone/Fax

Phone 2

Fax 2

Continue

Membership Application

This form will take approximately 5-10 minutes to complete

How do I know which District Branch or State Association I should apply through?