Michigan Association of School Psychologists
Membership Application
2013-14
Please return this form with payment to:
MASP c/o Katie Williams
254 Hunters Trail
Ann Arbor, MI 48103
(Please print. Submit one application per member.)
New
Renewal
RenewalName ________________________________________E-Mail (please print clearly!)______________________________________Check here if all information remains the same as previous year. If you were a member last year and
Check here if all information remains the same as previous year. If you were a member last year andare renewing, you only need to indicate any information that has changed and sign the application.
Mailing Address______________________________City _________________State________Zip______________Home Phone or Cell_______________________Work Phone_______________________Ext.____________Employer__________________________________________County of Employment______________________________MEMBERSHIP TYPE
$80Current School Psychologist
$80Current School Psychologist $80Consultant, supervisor, or administrator in school psychological services or related area
$80Consultant, supervisor, or administrator in school psychological services or related area $80Primarily engaged in training of psychologists in a college or university
$80Primarily engaged in training of psychologists in a college or university $25Retired
$25Retired $25Student in a Michigan college or university enrolled in at least 6 semester hours leading to a degree in school psychology and not employed full time.
$25Student in a Michigan college or university enrolled in at least 6 semester hours leading to a degree in school psychology and not employed full time. STUDENTS: Must be enrolled in at least 6 semester hours and not employed full time.
STUDENTS: Must be enrolled in at least 6 semester hours and not employed full time.Name of College/University
Signature of Adviser:_______________________________________________________________________________________________________________________________
Method of Payment
Check enclosed payable to MASP
Check enclosed payable to MASPCredit Card Charges
All Credit Card charges must now go through our on-line processing. Please go to www.maspweb.com and click on Membership.
That link will take you to PayPal where you can renew your membership. You do not need to forward this application to us.
MASP respects your right to privacy. Periodically, in an effort to support University-sponsored research, MASP may
share membership information. Please indicate here if you do not want your information shared.
The above information is true and correct to the best of my knowledge:
Signature:___________________________________________________________________ Date: ______________________
