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Academy Membership Form

We welcome your interest and involvement.  If you would like to join the Academy, please print this form, fill it out and mail it to the address printed below.

The application form can be printed in Word Document or PDF format. Please select the Membership category that represents your desired membership status and pay the dues amount (in U.S. dollars) for that category.  

 

Make your check payable to Academy Account and send it to:

Academy for the Study of the Psychoanalytic Arts
c/o Bethann Kalt, Ph.D.
32255 Northwestern Highway, Suite 250
Farmington Hills, Michigan, USA 48334