Fill out form, print, and send with check for 1st year dues payable to PSPP to Membership Chair:

Jeanne Seitler, Psy.D. 
10 Wilsey Square Suite 300
Ridgewood, NJ 07450

Membership Category:	Full      Early Career     Retired      Associate
	Student: Current Graduate Institution
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I am a member of:	American Psychological Association
NASW	APA Division 39
PSCSW	PA Psychological Association