International Section of APA Division 17

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Membership Form

Welcome to International Section of Division 17! Please fill out this form to become a member or update information.

This is for... *

New Membership Application

Updating Existing Membership

First name *

Last name *

Affiliated University/Organization *

Job Title/Position *

Please skip if you are a student

Email Address *

Alternative Email Address *

Country of Origin *

Country of Residence *

Membership Status *

US-Based Member ($10 per year)

US-Based Student Affiliate ($5 per year)

International Professional Affiliate (Free)

International Student Affiliate (Free)

Lifetime Member (one time prorated $100 or more)

Have you paid your dues for 2023-2024 (effective August 2023-July 2024)?

Yes

I'm a Lifetime Member.

I'm an International affiliate (professional/student) - Dues waived

I'm not sure. [Please email Treasurer Mijin Kim, to verify.]

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Areas of Interests

Please check all that apply

Research with international populations, cultures , or orgnaizations

Service (e.g. counseling, prevention, etc) to individuals communities, cultures, and organizations

Teaching and training

Policy development and implementation of cross-cultural issues

Networking and supporting counseling psychologists and other mental health professionals

Promoting cross-cultural collaboration among counseling organizations across the globe

Other:

Please check the committees you participate in or would like to join

Practitioner Committee

Faculty Committee

LGBTQ+ Committee

International Mentoring and Orientation Committee (IMOC)

Are you a Division 17 member? *

Division 17 membership is NOT required to join the International Section

Yes I'm a Division 17 member

No I'm not a Division 17 member

Other:

Required

Are you planning to attend the 2024 APA conference? *

Yes. I plan to attend in-person.

Yes. I plan to attend virtually.

Maybe

Are you planning to attend the 2024 APA conference Div 17 International section meeting? (Date/time to be determined.) *

Yes. I plan to attend in-person.

Yes. I plan to attend virtually.

Maybe

Membership Dues: $10 annually

If you are a US-Based member, please send $10.00 by check. Make checks payable to "Division 17 International Section" and mail it to the following address:

Mijin Kim, Ph.D.

3905 Kirby Dr.

Denton, TX 76210

For questions about dues, please contact Dr. Kim at mjkim.uh@gmail.com

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