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Online Membership Registration Form
Membership Category Applied for
Affiliate Associate Full Diplomate Fellow
US$ 15.00 US$ 25.00 US$ 40.00 US$ 40.00 US$ 75.00
+ US$ 10.00 Application Processing Fee
+ US$ 30.00 Plastic ID Card & Membership Certificate
Title
Prof. Dr. Mr. Mrs. Ms.
First Name *  
Middle Name  
Last Name *
Date of Birth *   (dd/mm/yyyy)
NIC No.  
Photograph  
Please browse and attach a Stamp Size Photograph for the Membership ID
Home Mailing Address *
   
Home Telephone *
Office Telephone *
Fax  
Email *
Professional / Occupational Details
Position *
Institution /
Practice
*
Address *
Country *
Preferred Address of Correspondence
Home Office
List Degrees and / or Certificates *
Please enter above details in the following sequence - Degree, Date, Major Subject, Institution, Location
Experience *
Professional
Memberships
 
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AFFILIATE MEMBERS ONLY
Institution  
Major Profession  
Anticipated Degree  
Date      (dd/mm/yyyy)
     
 
“I agree to be a member of INSTITUTE OF PROFESSIONAL PSYCHOLOGISTS and thereby give my consent for the Institute to hold limited personal information about myself (e.g. name, address, phone, fax, email, URL and research interests) on an electronic database for administrative purposes of the Institute.  I understand that this database will also be available on the Institute’s website (with protected password access for members).  I also understand that the society may make a membership list available to the members of the INSTITUTE OF PROFESSIONAL PSYCHOLOGISTS, who request it for research purposes.”
 
 

 

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                   Institute of Professional Psychologists,      Coordinating Office - 22A, 4th Lane, Ratmalana, Sri Lanka.                     Phone: +94 11 3172677        Fax: +94 11 2612951        Email: info@ProPsy.org

 

 

Last Reviewed 04/04/2012