Contact Information |
| First Name |
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| Middle Initial |
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| Last Name |
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| License Number |
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| Degree(s) |
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| Date of Birth |
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| Gender |
Female:
Male:
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| OPA member or affiliate group that referred you |
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| Have you been a member of OPA in the past? |
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| Professional Field (i.e., clinical, counseling, child, I/O, neuropsychology, developmental, MR/DD, rehabilitation, alcohol/drug) |
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E-Mail Address (OPA does not release e-mail addresses, but they are included in the membership directory) |
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| Web Site |
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The OPA is authorized to communicate with me via: |
Fax:
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| Email:
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| 4-digit PIN (letters and/or numbers) for website access: |
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| Your Ethnicity: |
American Indian/Eskimo
Appalachian
Asian/Asian-American
Black/African American
Hispanic/Latina/Latino
Pacific Islander
White/European American
Bi/Multi-Racial
Other
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| Psychological Setting: |
Academic/Research
Business
Hospital
Military
Private Practice
Public Sector
Retired
Other
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| Average Annual Salary from Psychology: |
0 - $19,999
$20,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
$80,000 - $99,999
$100,000 - $124,999
$125,000 - $149,999
$150,000 and above
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OPA-PAC (Political Action Committee)
OPA-PAC supports state political activities that impact psychologists and consumers by contributing to campaigns and candidates that can make a difference for our members. As an unincorporated political action committee, contributions are not tax deductible. No corporate checks or corporate credit cards can be accepted for payment of your OPA-PAC donation. |
Personal Visa or MasterCard only - no corporate checks
Contribution amount (suggested $25): enter Amount $
.00 |
OPA Project Fair (Focused Advocacy Insurance Reform)
OPA Project Fair was founded in 1997 to address the mounting concerns psychologists have with managed care and insurance company problems. Contributions are tax-deductible. |
Contribution amount (suggested $10):
enter Amount $
.00
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The Foundation for Psychology in Ohio (PSYOHIO)
The foundation is a non-profit, charitable organization that supports educational programs, scholarships, science day prizes, research, and other programs that benefit the science and practice of psychology. Contributions are tax deductible.
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Contribution amount (suggested $15):
enter Amount $
.00
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Membership Dues:
Optional Services:
Contributions:
Service Fee:
Total Due Today.
(If you choose payments the amount will reflect the amount of each payment)
*If paying in installments, your card must not expire before 08/12.
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Your dues include a subscription to The Ohio Psychologist, The Ohio Psychologist Review, and The Ohio Psychologist Update ($50 value).
Deductibility: Dues payments, contributions or gifts to the Ohio Psychological Association are not tax deductible as charitable contributions for tax purposes. They may be deductible as ordinary and necessary business expenses subject to the restrictions imposed as a result of lobbying activities. OPA estimates that for the association’s fiscal year September 1, 2010 to August 31, 2011, 20% of dues were allocated to lobbying activities and are non-deductible; OPA estimates that for the association’s fiscal year September 1, 2011 to August 31, 2012, 20% of dues will be allocated to lobbying expenditures and are non-deductible. |
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