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Association of Advanced Practice Psychiatric Nurses

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Thank you for joining AAPPN!

Please note that this form is for new memberships. If you are already a member of AAPPN, please use the AAPPN membership renewal form.

Payment Options

AAPPN offers a quarterly payment option for the Clinical, Emeritus, and Out-of-State membership levels and a bi-annual payment option for the Student membership level. Please note, if you select a quarterly or bi-annual payment option, your membership will automatically renew on an annual basis and your credit card on file will be charged.

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Membership Information
Please select your membership type and ANCC Certification.
Membership Type
Clinical Membership*
- Pay Total $250
- Quarterly Payments $62.50
Out-of-State Membership*
- Pay Total $150
- Quarterly Payments $37.50
Emeritus Membership*
- Pay Total $100
- Quarterly Payments $25
Student Membership*
- Pay Total $50
- Bi-Annual Payments $25
Total Due Today
$0.00
ANCC Certification*
check all that appy
- Adult Psychiatric and Mental Health Nurse Practitioner
- Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan)
- Clinical Specialist in Adult Psychiatric and Mental Health Nursing
- Clinical Specialist in Child and/or Adolescent Psychiatric and Mental Health Nursing
- Student
- Other (An AAPPN representative will contact you)
Graduation Date
When do you anticipate graduating from your program?
Personal Information
Please tell us the best way for AAPPN to contact you. The address, email, and telephone numbers you provide in this section will not be shared.
Name*
First Middle Initial Last Professional Credentials
Preferred first name or nickname
Email*
AAPPN will use this email address for our monthly eNews, as well as other news and announcements. If you wish to decline this member benefit, please let us know.
For AAPPN Use: Mailing Address*
Street Address Address Line 2 City State ZIP Code
For AAPPN Use: Day-time phone*
For AAPPN Use: Alternate day-time phone
County*
Display Personal Information
For Students and Retired Members only. Check this box if you want your personal information to be shared on the AAPPN Member to Member Directory.
- Yes Display Personal Information
Member Benefits
Please tell us which chapter or special interest group you would like to join, whether you would like to participate in AAPPN's listserv, and whether you would like to be listed in AAPPN's directories.
Chapter*
- At Large
- East King County
- Olympia
- Peninsula
- Portland
- Seattle
- Snohomish
- Spokane
- Tacoma
- Vancouver
- Whatcom/Skagit
Special Interest Group
- CAPAPN (child/adolescent)
AAPPN Listserv Opt-In*
- Yes
- No
AAPPN Directories*
Do you want to be listed in AAPPN's directories? Public = Visible in Public Referral Directory & the AAPPN Member-to-Member Directory | Private = Visible in the AAPPN Member-to-Member Directory Only | Unlisted = Not displayed in either directory
- Public Referral Directory
- Private - AAPPN Members Only
- Unlisted

Practice Information
Please tell us a little about your background and practice area. This information may be shared on the Public Referral Directory and on the AAPPN Member-to-Member Directory.
Age Groups
check all that apply
- Adult
- Child/Adolescent
- Couples/Families
- Older Adult
Demographics
check all that apply
- Academic Issues
- Addictions incl Gambling/Sexual/Internet
- ADHD/Executive Functioning
- Alcohol or Drug Addiction
- Anger Management
- Anxiety/Panic Attacks/OCD
- Autism Spectrum Disorder
- Bipolar Disorder/Mood Disorders
- Depression
- Eating Disorders
- Grief & Loss
- Insomnia
- LGBT/Sexual & Gender Minority Issues
- Personality Disorders
- Post Traumatic Stress Disorder
- Relationship Issues
- Schizophrenia
- Sexual Dysfunction
- Sleep Disorders
- Work Issues
Modality
check all that apply
- CBT (Cognitive Behavioral Therapy)
- DBT (Dialectical Behavioral Therapy)
- EMDR
- Family therapy
- Medication management
- Mind Body Approaches
- Mindfulness
- Pharmacogenetic Testing
- Psychotherapy
- Telecounseling/Telemedicine

Practice Description
This area can be used to provide a brief description of your practice, which will be published in both directories. You can also use this space to name modalities, issues treated, etc., not listed elsewhere.
Work setting
check all that apply
- Private Practice
- Community Mental Health
- Hospital
- Other
Do you accept insurance?
Leave unchecked for No.
- Yes
Primary work contact info
Address
Street Address Address Line 2 City State ZIP Code
Primary Work Telephone
Alternate Primary Work Telephone
Primary Fax
Primary Work Email
Primary Work Website
Secondary work contact info
Address
Street Address Address Line 2 City State ZIP Code
Secondary Work Telephone
Alternate Secondary Work Telephone
Secondary Fax
Secondary Work Email
Secondary Work Website
Bio Photo
Photo
Upload photo to be used in your bio area.
Accepted file types: jpg, gif, png.

Total Due Today
$0.00
Credit Card

Card Details

Cardholder Name
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Contact

1229 Cornwall Ave
Suite 308
Bellingham, WA 98225

360-734-3166
info@aappn.org

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