Membership Application Name(Required) First Last Home Email(Required) Type of Membership(Required) Regular Member - $25.00 Student Member - $15.00 Retired Member - $15.00 Associate Member - $15.00 Please check all certifications which currently apply to you.(Required) Nationally Certified School Psychologist Licensed School Psychologist Licensed Clinical Psychologist Broward County Recognition Program Other Other Certifications(Required) CommitteesPlease consider joining one of our committees! Indicate your interest: Community Service (Volunteering in the community and donation collections) Professional Development Committee (Select topics and speakers for trainings) Social Events (Planning the End of Year Luncheon and other events) CEU coordinator (Providing CEU purchase opportunities for colleagues) School Psychology Week (Help promote School Psychology Week) BASP Website and Technology Needs Membership Coordinator (Works with the Treasurer to keep membership records) BASP hopes to offer a few training opportunities throughout this school year. Please write down some topics that you would be interested in.Payment Options(Required) Pay by Check (Payable to BASP) - Pony to: Robin Taylor at Psychological Services Square (Pay Online) Credit Card(Required)Please check your Square settings. 99577