Application

MEMBERSHIP APPLICATION

I would like to join NYAPT Inc / APT Inc.
as a (check one):

______ Member: $100 for dual membership annual dues / publications
(Master’s, Doctorate / equivalent)

______ Affiliate: $60 for dual membership annual dues / publications
(Students/other individuals)

Name: _________________________________________________________

Degree: _______________ Affiliation: _________________________________

Address: ________________________________________________________

City: _____________________ State: ________________ Zip Code: ________

Phone: ___________________ Email: _________________________________

FAX: _____________________

Please make your check (in US dollars) out to:
The Association for Play Therapy Inc.

Mail membership form and payment to:
The Association for Play Therapy Inc.
3198 Willow Avenue, Suite 110
Clovis, CA 93612