2025 ASPP Membership Form

I am applying for:

Active Membership ($110/year)

Out of Town Membership ($55/year)

Joyce Bloom Candidate/Student Membership (FREE to candidates currently enrolled in courses and students currently enrolled in a degree program)

First name

Last name

Please use my 2024 ASPP Membership information AND I give ASPP permission to print this information, in its entirety, in the 2025 Member Practice Directory (if you do not check this box, please proceed to fill out the remainder of this form)

Analytic Training

Certified Psychoanalyst

Advanced Candidate in Psychoanalytic Training

Candidate in Psychoanalytic Training

N/A

I give ASPP permission to print my name, credentials, and analytic training in the 2025 Member Practice Directory.

yes

no

Address

This address is (check all that apply)

My Home Address

My Office Address

I give ASPP permission to print this address in the 2025 Member Practice Directory.

yes

no

Phone

This phone is (check all that apply)

Office

Home

Cell

I give ASPP permission to print this phone number in the 2025 Member Practice Directory.

yes

no

Email

I give ASPP permission to print this email in the 2025 Member Practice Directory.

yes

no

Please write in up to 3 specializations

Insurances Accepted:

Out of Network

In-Network

I see patients (check all that apply)

In-Person

Virtually

Licensure (check all that apply)

New York State

PsyPact Provider

I am not a licensed clinician

Other State(s) Licenses

2025 ASPP Membership Checkout:

2025 Active Membership$110

2025 Out of Area Membership$55

Joyce Bloom Candidate/Student Membership$0

Adelphi Society for Psychoanalysis and Psychotherapy

2025 Membership Form

Members joining after March 21st will not be included in the 2025 Member Practice Directory...

2025 ASPP Membership Form