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Members who haven't indicated their ethnicity or race on their membership records are encouraged to do so and to join one of the minority/underrepresented group caucuses.

Name ________________________

Phone ________________________

E-Mail ________________________

These are the ethnicities/races listed on the APA membership application:

• American Indian/Eskimo/Aleut/Native Hawaiian
  
• Mexican/Mexican American
  
• Puerto Rican
  
• Other Spanish descent (Cuban, Central American, or South American)
  
• Filipino
  
• Indian/Pakistani/Ceylonese/Malay
  
• Japanese/Chinese/Korean/Other Asian
  
• African American/Black
  

These are the seven APA minority/underrepresented group caucuses:

• American Indian/Alaska Native/Native Hawaiian
  
• International Medical Graduates
  
• Gay/Lesbian/Bisexual
  
• Hispanic
  
• Asian American
  
• Black
  
• Women
  

Members can provide this information to APA's Membership Department by e-mail to apa{at}psych.org or by phone at (888) 357-7924 or by mailing this form to APA Department of Minority and National Affairs, Suite 1825, 1000 Wilson Boulevard, Arlington, Va. 22209.

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