Join AVAPL As A New Member

New members may join AVAPL for $50 for their first year. For an explanation of the levels of membership, please click here. Please complete the following form (all fields are required except for those in red italics) and click the "Submit" button to go to the payment page. Thanks for your interest in AVAPL!

First Name:  
Last Name:  
Degree:  
Job Title:  
Facility:  
Location:  
Street Address:  
Address (cont.):  
City:  
State:  
ZIP Code:  
Work Phone:  
FAX:  
E-mail Address:  
We are interested in identifying those AVAPL members who are early in their career with VA. Please indicate below whether or not you are an early-career VA psychologist.
Length of Time Employed by VA Five years or less
More than five years.  
Membership Type:  

 

If you want to pay for your membership by mail, please print out this page and mail it along with your check, made payable to AVAPL. For the address to send your application and check, please e-mail Ann Landes, Treasurer, at trea...@avapl.org (In order to thwart spammers, clicking on the above e-mail links requires you to respond to a "challenge" before the e-mail address is revealed. You need to click on the underlined ellipses [...] to activate the link.)

If you would like to pay by credit card, click the "Submit" button below to submit your application electronically and to go to an internet site where you can enter your credit card information. Click "Reset" to clear the above information and start over.