Membership Application




  • Granite Mountain Psychological Society Membership Application/Renewal

  • New applicants and renewals requesting change in status please complete this section.

  • New applicants please complete this section

  • By submitting this document, Psychologists (applicants and renewals) attest to the following:

    Ethics Declaration: Granite Mountain Psychological Society is associated with the Arizona Psychological Association and the American Psychological Association. Members of the Granite Mountain Psychological Society support the objectives of the American Psychological Association as set forth in Article 1 of their Bylaws. The Granite Mountain Psychological Society has adopted the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. By signing this application, you agree to adhere to the principles contained within that Code.

    Copies of the APA Bylaws and/or Ethical Principles are available from the APA, 750 First St., NE, Washington, DC 20002-4242 upon request.

    Please be sure to:

    • Provide complete information. Incomplete information will delay processing of your application.
    • You may pay online using the below link or enclose your check, payable to the Granite Mountain Psychological Society . Checks may be mailed to: Doug Bergstrom, PhD, 143 East Merritt St., Prescott, AZ 86301

    Granite Mountain Psychological Society by-laws state that members have until October to renew and that after that time they will be dropped.

  • Full Membership in the Society is open to persons who:

    1) Hold a graduate degree in psychology or a related field that is mostly psychological in nature, and

    2) Are currently, intend to or have been professionally active in psychology or a related field that is mostly psychological in nature, as evidenced by

    a) licensure from the relevant State Board or

    b) employment as a practitioner, educator, or researcher in psychology or a related field that is mostly psychological in nature, and

    3) Adhere to the ethical principles and code of conduct articulated by the national association that represents their profession.

    Full Members have voting privileges and can hold office in the Society.

    Affiliate Membership in the Society is open to:

    1. Student affiliates. A student pursuing a degree in a program that is mostly psychological in nature. Student Affiliates, please provide a copy of your student identification card or a letter from a faculty member regarding your status.
    1. Community affiliates – individuals who show an interest in the purpose of the society.

    Membership in the Society shall be granted upon determination that an applicant has met the criteria for membership.






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