Unit #103, 1207 – 91 Street SW, Edmonton, Alberta T6X 1E9
Telephone: (780) 424-0294
Toll Free
1-888-424-0297
Fax:
(780) 423-4048
Toll Free Fax 1-888-423-4048
Email:
paa@psychologistsassociation.ab.ca
2014 M EMBER R ENEW AL N O TICE
( PLE ASE PRINT )
Name:
____________________________
Bus. Phone:
_______________________
Extension:
_______________________
____________________________
Cell Phone:
_______________________
____________________________
Res. Phone:
_______________________
Province: ____________________________
Fax:
_______________________
Post Code:___________________________
E-mail:
_______________________
Address: ____________________________
City:
Psychological Assistant Affiliate Membership - practices within the scope of practice of
psychology (as defined in Section 22 of the Health Professions Act); and practices under the
supervision of a registered psychologist; and holds a Bachelor’s Degree
Donation to the PAA Psychological Services Fund. A tax receipt will be sent to you from the
Community Foundation.
PLEASE COMPLETE THE INFORMATION BELOW 
TOTAL:
Work Setting (please check all that are applicable):
Private Practice ____
Schools ____
AB Gov’t Social Service Agency ____
Business/Corporate ____
Private agency NGO ____
WCB ____
EAP/EFAP agency ____
Unemployed or retired ____
Corrections ____
Leave (e.g. maternity or sick leave) ____
Universities/Colleges ____
AHS Comm. Mental. Health ____
AHS/Covenant Health - Hospital or Clinic ____
Federal Gov’t (other than corrections, e.g. FNIH, RCMP) ____
Primary Care Network/Family Care Clinic, or Shared Care ____
Other (please specify): ________________________________________________________
$190.00
(optional)
$____________
$____________
Psymposium:
 Online
Or
 Paper Copy
Ensure your email
address is provided
above
Membership Fees are due no later than April 1, 2014. An administration fee of $35.00 will be charged for all renewals
received after April 30, 2014.


Cheque or
Credit Card (VISA, MasterCard, American Express)
Card # _______________________________________________________________________Expiry Date: _______________
Name on card:______________________________________________ Signature _____________________________________
2
PAA VOLUNTEER OPPORTUNITIES
Name: _________________________________________________
Location: Edmonton________
Calgary_______
 Interest in all General Volunteer
Opportunities
OR
Out of Town_______
 Please identify the area(s) you are
interested in below.
PAA Committee Volunteer Opportunities
 Psychologically Healthy Workplace Committee
 Public Education Committee
 Continuing Education Committee
 Other PAA Committees/Task Forces that may arise
Specific events with approximate time frame of the year:
 Learning Disabilities
Association of Alberta –
November.
 Calgary Teachers
Convention – February
 South Western Teachers
Convention – February
 Edmonton Teachers
Convention – February
 Edmonton Regional
Science Fair – April
 Alberta College of Family
Physicians – February
 Calgary Youth Science
Fair – April
 The Central Alberta
Regional Science Fair –
March
IMPORTANT INFORMATION!
Privacy Legislation for Marketing
We have previously asked you to provide us with your choice as to whether or not you wished to be
placed on the mailing lists for non-PAA communications. If we did not receive a response from you, we
automatically assumed that you did not wish to receive external communications. If you indicated that
you did want to receive non-PAA communications, we have indicated this on your records in our
database.
If you wish to change your selection for non-PAA communications, please contact our office in writing.
Otherwise if you are currently receiving non-PAA communications, you will continue to do so until you
advise us otherwise. If you are not receiving non-PAA communications and you wish to start receiving
them, please contact us in writing providing consent to add your name to the external mailing lists.
If you are uncertain as to the choice you have previously selected, please do not hesitate to contact the
PAA office and we will confirm this with you.
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Thank you for supporting your professional association!