Membership Renewal - $100

First Name:*
Last Name:*
Degree:
Licensed Clinicians must complete this section
Ex.: PhD, MA

Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone No:*
- Area Code Phone Number
E-mail:*
Website URL:
Ex: Professional Sites, Blogs, etc.
Professional License No:
Licensed Clinicians must complete this section
Dimensions of Practice:
Licensed Clinicians must complete this section

Contemporary Psychoanalysis/Psychotherapy Coaching/Cognitive Behavior Therapy/Counseling Crisis Intervention/Critical Incident Stress Debriefing/EMDR Diagnostic Testing/Evaluation Gay/Lesbian/Transgender Issues Group Therapy Marital/Couples Therapy Play Therapy Psychodynamic Psychotherapy Psychotherapy Supervision Traditional/Classical Psychoanalysis
Are you currently a member of APA, Division 39?:

Yes, I am a member. No, I am not a member.
Education and/or Psychoanalytic Training Institute
Licensed Clinicians must complete this section
Grad/Post Grad University:
Year Graduated:
Psychoanalytic Institute:
Location (City):
Year Graduated:
Curricula Vita
Licensed Clinicians must complete this section.
Please Attach a Copy of your Curricula Vita. (Clinicians Are Required to Upload CV For Membership Consideration.)
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Membership Listing

Arizona Society for Psychoanalytic Psychology offers members the opportunity to list their
contact information and Website URL with link to your site on our "Membership" page.
Share Your Information?:*

Yes, AzSPP may create a listing for me on the "Membership" page. No, I would not like AzSPP to create a listing for me.
Membership Terms Agreement

I hereby apply for membership in the Arizona Society for Psychoanalytic Psychology. By checking the "I Agree" box below, I agree
to comply with the requirements of the Code of Ethics, Standards of Conduct, Bylaws and all regulations
adopted by the Arizona Society for Psychoanalytic Psychology and the American Psychological Association, Division 39.
I Agree with Terms*

I agree

The Executive Committee of AzSPP

Janine Button, LCSW, President, 2023-24
Michael Hanafin, MEd, MAPC, Secretary, 2017-Present
Vaughn Tsoutsouris, Member-at-Large

Past Presidents

Lisa Colangelo Fischer, PhD, ABPP, Past President, 2021-22
Craydon McDonald, PhD - R.I.P., Past President, 2019-20
Florence Rosiello Chevalier, PhD, Founder and Past President, 2017-18