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2008 Membership Application (Print or download and Mail) Name, Highest Degree: Mailing Address: City, State, Zip: Phone, Fax: E-mail Address: Status: ______$75 Members (Includes subscription to Neuropsychology) ______$50 Post-Docs (Includes subscription to Neuropsychology) ______$40 Students (Includes subscription to Neuropsychology) ______$20 Post-Docs (Includes reduced admission to symposia) ______$10 Students (Includes reduced admission to symposia) Are you a first time member-applicant to PNS? Y / N Do you wish to receive e-mail notification of local psychology events/talks? Y / N Do you wish to make a donation to PNS' "scholarship initiative" to fund scholarships for graduate student awards (please include donation with dues check). Y / N Please mail application and check to: Mary Lazar, Psy.D. PNS Treasurer Widener University Neuropsychology Assessment Center One University Place Chester, Pa 19013 |