Texas Speech-Language Hearing Association

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Inside the TSHA Site:

Consumer Information

Student Information

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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
Please complete this form completely. TSHA membership runs from January through December. Dues are not prorated. Memberships received after October 1st will include the remainder of the 2008 year, and all of the 2009 calendar year. 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 should 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 your state license.
Name, Address & Employment
* Required Fields
* First Name:	* Last Name:
Former:	* Employment:
* Title/Position:	* Home Address:
* City:	* State:
* Zip:	* Phone:
Fax:	Cell:
* Business Address:	* City:
* State:	* Zip:
* Phone:	Fax:
* Email:	Preferred Mailing Address: Home Business
Preferred Phone: Home Business

* Membership Category
Active Membership	Annual Dues $80.00	Master's or Doctorate in the profession
Associate Membership	Annual Dues $75.00	Bachelor's Degree
Affiliate Membership	Annual Dues $45.00	Any Interested Party who DOES NOT qualify for either Active, Associate, or Student Membership.
Student Membership	Annual Dues $25.00	Minimum of six hours required. Student members must identify program coordinator who can verify student status.

Degrees, Certifications, Specialty & Regional Association Memberships
Highest Degree:	Ma:
Areas of Specialization:	Dates:
Institutions:
Primary Specialty: Speech-Language Pathology Audiology Deaf Education Other
ASHA Member?: Yes No	ASHA Certification: CCC (SLP) CCC (A) CCC (SLP/A)
Other Association Memberships:
TEA Certification, Provisional All Levels?: Yes No	Texas License?: Yes No License #:
Texas Licensed Assistant?: Yes No License #:
Bilingual?: Yes No Language(s):
Primary Professional Setting: Public Schools University Non-University Hospital Clinic University Hospital Clinic Private Practice Community Agency Other	Secondary Professional Setting: Public Schools University Non-University Hospital Clinic University Hospital Clinic Private Practice Community Agency Other

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

How did you hear about us?: Convention Membership Brochure Friend Other

Total Charges: $

Please charge my: American Express Discover MasterCard Visa
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:

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

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