Please complete and submit this form Online to the national office.
If you prefer to pay by check print this form and mail with payment to: ASGPP 301 N. Harrison Street, Suite 508, Princeton, NJ 08540 USA.
Licenses/Certifications: Present Occupation:
Affiliation/title ONLY IF used in address:
State: Zip: Country:
Phone: Fax: E-mail:
Type of Membership:
Regular (yearly membership dues -$120)
Retiree (yearly dues - $60)
Student(yearly dues - $60)*
* Students must be matriculating in an accredited college/university and carrying a minimum load of 9 credits and/or pursuing a full-time residency or internship. Students must submit a photocopy of college/university picture identification.
I am from a country other than US, Canada or Mexico (additional $10 to cover mailing costs).
I would like a membership certificate (additional $15 )
How did you hear about the ASGPP?
Ad in publication
ASGPP member who encouraged you to join (if applicable):
THIS IS A RENEWAL