NYS ATSA Membership Form

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Please fill out the form below to finalize NYS ATSA Membership! You may pay your dues online as well.

CLINICAL MEMBERS ($35): To pay annual clinical membership dues, please do so HERE.
STUDENTS ($20): To pay annual student membership dues, please do so HERE

Email *

Name *

Today's Date *

YYYY

Is this a membership renewal or a new member application? *

Membership Renewal

New Member Application

Your Company/Organization

Professional Credentials (If applicable) *

Business or Mailing Address *

NY Region or Other Area *

Hudson Valley

NYC

Long Island

Capital Region

Western New York

Finger Lakes

Central New York

Other:

Phone number *

Identified Discipline *

Outpatient Treatment - Adults

Community Supervision

Inpatient Treatment - Adults

Research/ Academia

Attorney/ Judge

SOTP Administrator

Victim/Survivor Advocate

Assessment and Evaluation

Inpatient Treatment - Juveniles

Outpatient Treatment - Juveniles

Other:

Required

What do you hope to get out of your NYS ATSA Membership? *

A copy of your responses will be emailed to the address you provided.

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