Membership Austin Psychoanalytic membership Membership Type * Full Member $150 Graduate Student Member $75 Retiree Member $75 Please renew my membership automatically each year. Membership will renew automatically. Total Amount Your Information First Name * Last Name * Work Email * Work Phone Licensure Category * PsychologistPsychiatristPsychiatric Nurse PractitionerLicensed Professional CounselorMarriage/Family TherapistSocial WorkerNon-licensed Licensure(s) CGP DO LCDC LCSW LMFT LMHC LPC MD MFT MSW NCC PhD PsyD LCSW-S LPCC LMSW LICSW LP Professional Website Street Address * City * Postal Code * Country * - select Country - United States Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo, Republic of the Congo, The Democratic Republic of the Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State * Choose country first Your Practice What are the services of your practice? Individual Therapy Couples Therapy Family Therapy Group Therapy Child Therapy Psychoanalysis Medication Management Case Consultation Clinical Supervision What age groups do you primarily work with? Child Adolescent Adult Senior What state(s) are you licensed in? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Guam Northern Mariana Islands Puerto Rico Virgin Islands Are you a member of PSYPACT? NoYes What insurance providers do you accept? Aetna Blue Cross Blue Shield Cigna United Medicare Tricare Humana Seton Smarthealth Out of network Sliding scale What appointment types do you provide? In-Person Virtual Membership Details Membership Directory I would like to be listed in the directoryI would like to be listed, but do not want my address includedDO NOT list me in the directory Are you a member of Division 39 of the American Psychological Association * NoYes Do you list Austin Psychoanalytic as your primary affiliation with Division 39? * NoYes Are you interested in volunteering to serve in one of the following areas? Membership and recruitmentSocial media and marketingSocial EventsPresidentTreasurerSecretaryDivision 39 representativePresentation ProgrammingScholarship Committee Payment Options Payment Method Credit Card Pay by check Submit Membership
