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American Association For Psychology And The Performing Arts

Membership Application Form

Date:____________________
Name:_______________________________________
Address:____________________________________
City:_____________________ State:_____ Zip:________
Telephone:_____________________________
Degrees:____________________________________________
Professional Associations:_____________________________
____________________________________________________

I hereby verify that all of the information contained in this questionnaire is accurate and true.

Signed:__________________________________

Membership Dues:

Full = $45.00
Student = $25.00

Please send signed application form, check or money order to:

AAPPA
430 Clematis Street
West Palm Beach, FL 33401
(561) 852-6868 or
(954) 755-8247
or
if you have any
questions, please EMAIL

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