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Inside the TSHA Site:

• About TSHA
• TSHA Forms
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 • Home

Consumer Information

• Education Service Centers
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• Better Hearing and Speech Month
• Career Awareness Resources
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Student Information

• Student Membership Application
• Student EB Application
• Student Member Benefits
• NSSLHA
• CAA Accredited Programs
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Contact Us

Texas Speech-Language-Hearing Association
918 Congress Avenue, Suite 200
Austin, TX 78701-2422

Toll Free: 1-888-SAY-TSHA
Phone: 1-512-494-1127
Fax: 1-512-494-1129
 Inside the TSHA Site
Search:

TSHA Membership Application

Submit the membership renewal online, or print, complete, and return to:
Print Membership Application

With questions contact the TSHA State Office
918 Congress Avenue, Suite 200
Austin, TX 78701
888-SAY-TSHA
Email

TSHA Membership Application
DO NOT USE THIS FORM IF YOU ARE CURRENTLY A TSHA MEMBER AND WISH TO RENEW, OR IF YOU HAVE BEEN A TSHA MEMBER IN THE PAST. Current and former TSHA members shoud fill out the TSHA Membership Renewal Form online. TSHA is not the state regulatory agency. Do not use this site to apply for or renew you state license. TSHA membership runs from January through December. Dues are not prorated. Memberships received after October 1st will include the remainder of 2009 and all of 2010. Contact information will be published in the online directory; however, home address will not be included unless it is your mailing address. Be sure to include your email address to ensure you receive TSHA updates and important notices.
Name, Address & Employment
Information you enter here will be imported into the TSHA database.  Please use proper upper and lower case.
* Required Fields  
* First Name:  
* Last Name:  
Former:
Employer:
Title/Position:
* Home Address (Required):  

Your home address is essential for identifying and contacting your federal and state legislator.
* City:  
* State:  
* Zip:  
* Home Phone:  
Fax:
Cell:
* Mailing Address:  
* City:  
* State:  
* Zip:  
Work Phone:  
Fax:
* Email:  
Preferred Phone:
* Membership Category   
Annual Dues $80.00 Master's or Doctorate
Annual Dues $75.00 Bachelor's Degree
Annual Dues $45.00 Any Interested Party who DOES NOT qualify for either Active, Associate, or Student Membership.
Annual Dues $25.00 Minimum of six hours required. Student members must identify program coordinator who can verify student status.
Degree, Certification, Specialties
* Highest Degree:
(Bachelors, Masters, PhD, AuD)
Primary Specialty:               
ASHA Member?:
    		TEA Certification, Provisional All Levels?:
   
Texas License?:
        License #:
Bilingual?:            Language(s):   
Primary Professional Setting:






Secondary Professional Setting:






(*Professional setting does not apply to student members.)

* How did you hear about us?:                   
                       
Total Charges: $
Please charge my:                
Please enter numbers only, no dashes or spaces.
Card Number: Expires:        
If the Name and Address listed on this application is different from the information that your credit card issuer has on file for billing purposes, the transaction will be rejected as a security measure. If the billing name and/or address is different from above, please enter the information below:
Name (exactly as it appears on credit card):

First:

Last:

Billing Address:
Billing City:
Billing State:
Billing Zip:

(Note: If the "Thank You" page is not displayed after clicking the "Submit Form" button, there is an error on the form. Scroll back through the form and find the error. [error message is in red text] Correct the error and click the "Submit Form" button again.)

      

PLEASE DO NOT PRESS THE SUBMIT BUTTON MORE THAN ONCE AS YOU MAY BE CHARGED EACH TIME.

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