House No.

10 (1
st
Floor), Street No. 44, F-6/1, P.O. Box 3355, Islamabad, Pakistan.
Email: secretariat@psychologypak.org , Website: www.psychologypak.org

Pakistan Psychological Association
Membershi p Form
I hereby tender my request for obtaining membership of Pakistan Psychological Association.
My particulars are as under:-
Name:

D/W/S/O:



CNIC #:

Designation/Institution:




Male

Married

Single

Sex: Female

Mailing Address:

District:

Contact: Phones: Fax:

Cell:

E-mail:



Qualification:

M.Sc. / M.A.

Year



M.Phil/M.S.

Year



Ph.D.

Year



Diploma

Year



Any Other

Year




Signature of Applicant:


Life Membership: Rs. 4,000/-

Annual Membership: Rs. 2,000/-

Associate Member (Not eligible for voting) Rs. 3,000/-

Student Member (Not eligible for voting) Rs. 500/-

All categories excluding Life Membership will be for a period of 2 years, CV, Last educational degree
and three recent Photographs are required.
UNDERTAKING BY THE APPLICANT(compulsory for all candidates)
I Mr. /Ms. ______________________ Son/Daughter/Wife of Mr .___________________certify that
the statements made by me in this form are true, complete and correct to the best of my
knowledge and belief. It is solemnly affirmed that I have deposited the life time membership
fee to earn the membership of PPA platform. I understand that the membership will be
withdrawn/ suspended as well as penalty will be charged if any misrepresentation or
violation of PPA constitution is discovered.
Date: __________________ Applicants Signature___________________________
(FOR OFFICE USE ONLY)

PAKISTAN PSYCHOLOGICAL ASSOCIATION

Form No. Receipt No. Date
Received Application for Membership (Life, Annual, Associate, Student, from

Mr./Ms.

Rs.



Additional Rs.500/- will be charged for membership certificate.

Recommended/Not recommended.


G. Secretary

President