CAPA | Join CAPA

Personal Information

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First Name:*

Last Name:*

Email:*

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Highest Degree:*

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Institute/School Street Address:* Institute/School Street Address Line 1

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Date Graduated:* Month Day Year

Please email all inquiries to Bonnie Evans at capabevans@gmail.com.

Be sure to click "Submit Form" at the bottom of the screen when you're finished. Upon doing so, you will be prompted to fill in any required fields before moving on to the payment screen.

Ethical Disclosure and Pledge

I hereby certify that, to my knowledge, there have never been any professional ethical charges or charges of unprofessional conduct against me. (Amplify if necessary). I agree to abide by the usual ethical codes of my professional organizations and my state licensing board in my dealings with Chinese patients, supervisees and students. I realize that Chinese customs may be different from usual Western ones (e.g., gifts, socializing) but I will follow Western mores.

Further, I will not allow my work in China to involve me in conflict of interest issues. If I suspect there are such issues, I will discuss them with the Ethics Committee.

If there have been ethical charges, please describe the outcome:

Signature

Use your mouse or finger to draw your signature below:*

Your signature indicates that you agree to abide by CAPA's Ethical Disclosure and Pledge as stated above, and also that any ethical charges, or the lack thereof, as you have detailed above, are accurate to the best of your knowledge.

Also, if you end up teaching or supervising with CAPA, please note that CAPA students register privately as therapists and supervisors with the Chinese Psychological Society (CPS), as there are many professional and financial benefits enjoyed by those who complete the official registration process. In order for our students to be able to do this, CAPA must provide CPS with a listing of the training and supervision hours they have completed, including the signatures and CVs of their instructors and supervisors. Upon signing, you agree that your signature and CV may be used for this purpose as well, should the occasion arise.

Upload Your CV

Please submit your CV with the form.*

Payment Information

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Membership levels

$50/year ACTIVE
$100/year SUPPORTING
$150/year SUSTAINING
$250/year PATRON
$500/year ANGEL

Mail check to:

CAPA c/o RC Business Service Inc.
212-80 16th Ave
Bayside, NY 11360

Your dues and contributions are tax-deductible (CAPA is a 501(c)(3) organization). You can contribute pre-tax money from your IRA and save in two ways - pre-tax money and a deductible contribution. Do what is best for you. You will be listed on our membership site on the basis of your total contribution to CAPA.

Membership Level:*

Please consider membership at a higher level.

Please note that, upon submission of this form, you will automatically be taken to another webpage to complete your payment, which will require you re-confirming your selection of membership level. Your subscription is not complete until you have completed payment through PayPal. Once you have completed payment, your CAPA membership will renew automatically, one year from the payment date. This means that an automatic charge of $0 will be made for annual dues each year to the credit card you provide. You can cancel your subscription at any time by contacting CAPA.

Your dues and contributions are tax deductible as a business expense and the donation is deductible as a Contribution (we are a 501(c)(3) organization). You can contribute pre-tax money from your IRA and save in two ways — pre-tax money and a deductible contribution. Do what is best for you. You will be listed on our membership site on the basis of your total contribution to CAPA. After you press the "PROCEED TO PAYMENT" button below you will be taken to the payment screen. PLEASE NOTE: PayPal is used to process both credit card payments and PayPal payments. You will receive an auto-generated receipt once you've completed the payment process.

Please Enter Any Additional Amount You'd Like to Contribute to CAPA:

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