2026 ASPP Membership Form

I am applying for:

Active Membership ($110/year)

Active Membership plus $10 donation to the Rick Hansen Scholarship Fund ($120/year)

Out of Town Membership ($55/year)

Out of Town Membership plus $10 donation to the Rick Hansen Scholarship Fund ($65/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 2025 ASPP Membership information AND I give ASPP permission to print this information, in its entirety, in the 2026 Member Practice Directory Please be certain that none of your information has changed before checking this box (if you do not check this box, please proceed to fill out the remainder of this form)

Analytic Training

Psychoanalyst (completed full Psychoanalytic Training)

Advanced Candidate in Psychoanalytic Training

Candidate in Psychoanalytic Training

N/A

Other Completed Analytic Trainings

I give ASPP permission to print my name, credentials, and analytic training in the 2026 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 2026 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 2026 Member Practice Directory.

yes

no

Email

I give ASPP permission to print this email in the 2026 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

2026 ASPP Membership Checkout:

2026 Active Membership$110

2026 Active Membership plus $10 donation to the Rick Hansen Scholarship Fund$120

2026 Out of Area Membership$55

2026 Out of Area Membership plus $10 donation to Rick Hansen Scholarship Fund$65

Joyce Bloom Candidate/Student Membership$0

Adelphi Society for Psychoanalysis and Psychotherapy

2026 Membership Form

Members joining after February 1st will not be included in the 2026 Member Practice Directory...

2026 ASPP Membership Form