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Please PRINT this page, fill it out and return it to the College by mail. Thank you.



American College of Forensic Psychology


First name, middle initial, last name:

Street, city, state (province), zip code:

Office telephone:

Fax number:

Email address:

Home telephone number (for our office use only):

Present affiliation:

Graduate degree/date/institution:

Currently valid unrestricted license (state and number):

Areas of specialty in psychology:

Please describe your experience in the legal system as expert, consultant, forensic institution, other.


Average number of hours per month doing forensic work:

Articles published:


(  ) I will send two copies of a recent curriculum vitae


(  ) Please find my check in the amount of $255 dollars for one year's membership in the College.


(  ) I will submit or send  2-3 letters of reference (attorney, judge, psychologist or psychiatrist)




American College of Forensic Psychology
PO Box 5899
Balboa Island, CA 92662

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