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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withdrawn/ suspended as well as penalty will be charged if any misrepresentation or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