The International Society
for the
Psychoanalytic Study of Organizations
Application for Membership
Membership in the ISPSO
is open to those who share an interest in applying psychoanalysis
to organizations.
Annual membership dues
are US$200.
Please note that the
application process takes approximately three weeks.
Instructions: Save this form to your computer's
hard drive. Open it in Microsoft
Word. Fill in the blanks,
save it as a Word document, and e-mail it as an attachment to Elizabeth Novogratz (Administrative Assistant).
Applying by e-mail will facilitate the application process. However, if you are
unable to email the document, please contact Elizabeth Novogratz for assistance:
Elizabeth Novogratz
117 South 3rd Street #3B
Brooklyn, NY 11211
USA
Telephone: 1 – 646 – 325 – 6422
Please
be sure that you have filled out the Statement of Interest and Brief Biography. Your application will not be processed
without them.
Please note that the application approval process takes approximately 3 weeks.
PERSONAL INFORMATION
First/Given:
Last/Surname:
Street
Town
or City: State/ Province:
ZIP
/Postal Code: Country:
Home
Telephone
Country
Code: Number:
EMPLOYMENT INFORMATION
Name
of Organization/Institution:
Title/Position:
Street
State/
Province:
ZIP /Postal Code:
Country:
Business Telephone
Country
Code: Number:
Business Facsimile
Country
Code:
Number:
Other
organizations you may work for:
Email Address where you wish to receive ISPSO email:
Field
of Study:
Degree:
Date Received:
POSTGRADUATE EDUCATION
1) College
/ University:
1)
Field of Study: Degree: Date Received:
2)
College / University:
2)
Field of Study: Degree: Date Received:
3)
College / University:
3)
Field of Study: Degree: Date Received:
Please
indicate any experience/training you have had in the
following areas:
A.
PSYCHOANALYSIS/ PSYCHOTHERAPY:
B.
GROUP DYNAMICS:
C.
ORGANIZATIONAL CONSULTANCY:
PROFESSIONAL
AFFILIATIONS:
PROFESSIONAL
HONORS:
STATEMENT
OF INTEREST (Required)
The
Membership Committee requests that you include in this application any
statement you care to make that you believe will be helpful in evaluating your
application.
BRIEF
BIOGRAPHY (Required)
(This
biography will be posted on our list-serve, to introduce you to our members.
It will also be placed on our website, along with the biographies of our
current members.)
Please write a brief description of
yourself covering the following points:
1.
The kind of work you do;
2. Organizations you work for or are associated with, along with an account of
the roles you hold in them;
3. Professional training you have had;
4. Special work interests you have, including particular interests you may have
in ISPSO.
LIST OF
PUBLICATIONS
(This
will also be posted on our website)
To help us better understand our members and the field, please answer the following questions
a. How
did you hear about ISPSO?
b.
What other professional organizations do you belong to?
c. What
journals do you regularly read?
d. What conferences do you regularly attend?
The membership of ISPSO includes a broad spectrum of
professionals. For the next question we ask that you list your primary
professional identifications. Please list these in order of time commitment
(from highest to lowest percentage time). Please use terms from the following
list if possible:
Academician/Educator
Manager/Administrator/Executive
Organizational
Consultant
Psychoanalyst
Therapist/Counselor
Other
If you list includes the choice of "Other" please describe this
professional role (E.g., physician, financial planner, minister).
Begin list here:
We look forward to receiving your application. Thank you!