Membership Application

Name

Date

Mailing Address

Street

City

State

Zip

Email

Business Phone

Cell Phone

Home Phone

Fax

Current Position / Place of Employment

Highest Degree Earned

Year

School

How did you hear about SLPA?

For Professionals:

Licensure State(s)

License Number(s)

Professional Memberships

Full Member APA

Full Member MOPA

Full Member IPA

OtherOther

For Students

Student advisor attestation of enrollment is required.

School

Department

Degree Program

Advisor (Name, Phone, Email)

I am applying for membership in the St. Louis Psychological Association:

All full and affiliate members who are fully licensed mental health professionals may elect to be included in the Find A Therapist section of the SLPA website. This optional listing includes name, practice location, telephone number, and clinical interest areas.

Along with the information listed above, an Enhanced Find A Therapist Listing adds photo, a personal statement, website address, email address, hours, specific insurance plans accepted, and a Google Map. An enhanced listing is available for an additional $30 per year ($90 total).

Membership Type

Full Member ($60):
According to the bylaws of the Association, eligibility for full membership requires meeting one of the following criteria: Full Member of APA, MOPA, or IPA, or Licensed Psychologist in Missouri or Illinois, or eligibility for the above.

Full Membership with Enhanced Find A Therapist Listing ($90)

Affiliate Member ($60):
Any person who has a professional interest in psychology may apply for affiliate membership. An Affiliate Member typically has a graduate or medical degree in a subject related to mental health (e.g., psychiatrist, clinical social worker, or licensed professional counselor).

Affiliate Membership with Enhanced Find A Therapist Listing ($90)

Student Member ($25):
Any person enrolled in an academic program that is primarily psychological in nature may apply for Student Membership.

Retired Member ($25):
Any member of SLPA may change to retired status upon reaching age 60 and complete retirement from all psychology-related employment.

Dues

You must complete payment in order for your application to be processed.

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Saint Louis Psychological Association

Mailing Address

For Professionals:

For Students

Find A Therapist

Join SLPA