ArPA Fall Conference New Member Bundle

Please complete this form to apply for the Affiliate New Member Bundle.
This special $196 bundle is only available to first-time members who are joining as an Affiliate Member of the Arkansas Psychological Association.
After submitting your application, you will be directed to secure checkout to complete your payment.

Your membership application will be reviewed by ArPA’s Membership Committee. If approved, you will receive an email confirmation with further details.

Personal Details

First Name *

Last Name *

Email *

Home or Cell Phone *

Facebook Profile Link

LinkedIn Account Link

YouTube Account Link

Twitter Account Link

Home Address

Professional Details

Year Licensed

Year of Degree (For students, please enter your anticipated year of graduation) *

Degree and Major (For students, please enter both your degree program and major) *

Place of Employment *

Work Address

Membership Applications Survey

What is your current professional title/role?

What is your highest level of education?

Please describe your professional work or practice.

What areas of psychology or mental health are you most interested in?

What do you hope to gain from being an Affiliate member of ArPA?

How do you see yourself contributing to ArPA’s mission to advance psychology in Arkansas?

Would you be interested in volunteering your time or expertise to ArPA initiatives? If so, how?

Are you currently involved in any other professional organizations or associations related to psychology or mental health? If yes, which ones?

Would you be interested in participating in ArPA events such as conferences, workshops, or webinars?

Professional Ethics Declaration

To your knowledge, are you presently under investigation by any organization or state licensing agency? *

Yes

Have you ever had any action taken against you by a professional organization or a state licensing agency? *

Yes

Have you had any judgments of malpractice entered against you? *

Yes

If you answered "yes" to any of the above items, please list below each instance, describing briefly the events leading up to the case, the outcome and its relevance to the practice of psychology. This information will be kept confidential. Failure to complete all questions and statements may result in a delay of application processing.

Explanation

Fall Conference Attendance Selection

Attendance Selection: *

I Will Attend Virtually

I Will Attend In-Person

Would You Like to Subscribe to the ArPA Members Only Email List? *

Yes

By clicking SUBMIT, I certify that I have read and I agree to abide by the Code of Ethics of the American Psychological Association. I also certify that all information on this form and any attached forms is true to the best of my knowledge.