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MANITOBA ASSOCIATION OF SCHOOL PSYCHOLOGISTS, INC.

MEMBERSHIP RENEWAL FORM

2010 - 2011 Fiscal Year

Name:  
Home Address: 
City:  
Province: 

Postal Code
Home Phone:  
Email Address: 
School Division: 
Work Address:  
City:  
Province:  
Postal Code: 
Work Phone: 

MASP Correspondence should be sent to my:

Annual membership dues for the 2010 - 2011 fiscal year have been set as follows:

 Full Member $75.00

 Affiliate Member $37.00

Retired Member $37.00

 Student Member $18.00

I request my membership as a member

I would like my name listed on the MASP website as a 

Psychologist Certified by Manitoba Education and Training

 

I agree to allow MASP to share my mailing address information for verified University research projects in the area of School Psychology

Please send this completed form and a cheque payable to the 

Manitoba Association of School Psychologists to:

 

Membership Chair

Manitoba Association of School Psychologists

162 - 2025 Corydon Avenue, Suite 562

Winnipeg, Manitoba

R3P 0N5