Registration
* This Field is required Required field | This Field IS visible on profile Field visible on your profile | This Field IS NOT visible on profile Field not visible on profile | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon
Thank you for your application. Your information will now be reviewed by a real human being, who will approve your membership. It could take a couple of days, but you'll be notified of the outcome via e-mail.
* This Field is required This Field IS visible on profile Information for: First Name : Please enter your real first name.
* This Field is required This Field IS visible on profile Information for: Last Name : Please enter your real last name.
* This Field is required This Field IS visible on profile Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required This Field IS visible on profile Information for: Username : Please enter a valid username.  No spaces, at least 3 characters and contain 0-9,a-z,A-Z
Your password will be sent to the above e-mail address.
Once you have received your new password you can log in and change it.
This Field IS visible on profile Information for: License Number: : <p>If licensed, please enter your license number.  </p>
This Field IS visible on profile Information for: Primary function? : <p>Clinical, research, teaching, etc.</p>
* This Field is required This Field IS visible on profile Information for: Directory : <p>Include me in the online directory?</p>
* This Field is required This Field IS visible on profile Information for: Licensed/Supervised/School? : <p>Are you licensed or supervised as a psychologist?</p>
This Field IS visible on profile Information for: Student : <p>Are you currently a student?</p>
* This Field is required This Field IS visible on profile
This Field IS visible on profile Information for: Member WVPA : <p>Are you currently also a member of WVPA?</p>
This Field IS visible on profile Information for: WVSPA Member : <p>Are you currently a member of the WVSPA?</p>
This Field IS visible on profile
This Field IS visible on profile Information for: Interests: : <p>Briefly list your professional interests (e.g., children, ADHD, research).</p>
This Field IS visible on profile
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile
This Field IS visible on profile
This Field IS visible on profile Information for: College Undergrad : <p>From what college did your receive your undergraduate degree?</p>
This Field IS visible on profile Information for: Graduate School : <p>From what institution did you receive your highest degree?</p>
This Field IS visible on profile
This Field IS visible on profile Information for: Year of Undergrad Degree : <p>In what year was your undergraduate degree granted?</p>
This Field IS visible on profile Information for: Year of Graduate Degree : <p>What year did you receive your highest degree?</p>
This Field IS visible on profile Information for: Years of Experience : <p>How many years of experience do you have in the field?</p>
This Field IS visible on profile Information for: Any Notes for Us: : <p>Any other information you feel we should have.</p>
Thank you for your application. Your information will now be reviewed by a real human being, who will approve your membership. It could take a couple of days, but you'll be notified of the outcome via e-mail.
* This Field is required Required field | This Field IS visible on profile Field visible on your profile | This Field IS NOT visible on profile Field not visible on profile | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon