NCSHLA Membership Center > Become-A-Member

Online ServicesNCSHLA Membership Begins Today

By joining or renewing your membership in NCSHLA, you demonstrate your commitment to advancing the professions of speech, language and audiology in North Carolina. NCSHLA members receive a wide array of benefits, including discounts on meetings, seminars, continuing education. This is only a small part of what makes your NCSHLA membership so valuable. The most important membership benefits are the contributions the association makes to the personal and professional lives of its members, and to those we help.

Joining NCSHLA is easy. Simply complete the following form. A representative from the Central Office will then follow up with you. If you have any membership questions, contact NCSHLA offices at (919) 833-3984 or via email at membership@ncshla.org

» NCSHLA Membership Application Download



NCSHLA Membership Application

The membership year runs from July 1st through - June 30th

Choose Application Type:
First Name:
Last Name:
Middle Initial:
Mailing Address:
City:
State:
Zip:
Home Phone
Work/School Phone:
Fax Number:
Email Address:

Employment
Employer or Training Program:
Work or School Address
City
State
Zip
County
Job Title

Choose Your Membership Type

Note: Memberships received prior to Sept. 1st will receive a $10 dues discount**

Active (Dues $90/yearly)* - Active members are voting members of the Association and enjoy all NCSHLA privileges. Active members are those holding at least a master's degree in speech/language pathology, audiology, speech/hearing science, education of the hearing-impaired or a related field, or other master's degree and evidence of research and/or performance in the field of communication disorders. Members in good standing of the American Speech-Language-Hearing Association are automatically eligible for Active status.
Associate (Dues $70/yearly)* - Associate members have all NCSHLA privileges except voting and holding office. Associate membership is open to those with less than a master’s degree and those who are currently employed in the professions of speech/language pathology, audiology or related areas, but who are not eligible for Active membership.
Student (Dues $25/yearly)** - Student members have all NCSHLA privileges except voting and holding office. Student membership is open to graduates or undergraduates majoring in speech/language/hearing or related areas in accredited North Carolina college, or university programs, but who are not eligible for Active membership.
Doctoral Student (Dues $25/yearly)** - Doctoral Student members are current, or eligible, for active membership of the Association and are enrolled in a doctoral program for speech-language pathology, audiology, or other related fields. You can apply for a reduced rate at the student level for up to three years and retain voting privileges. Proof of doctoral program enrollment must be attached for approval by the NCSHLA Membership and Recognition Committee. Doctoral students are required to submit an application and proof of doctoral program enrollment annually for approval.
Corporate Membership* - Corporate memberships are also available to entities interested in supporting the professions of speech/language pathology and audiology but are not otherwise eligible for membership (e.g., rehab agencies, private practices, hospitals, product suppliers, etc.) You can download complete Corprorate Member information or contact the NCSHLA Central Office for additional info.

*NOTE: NCSHLA dues are a business expense (not a charitable contribution) as allowed by federal and state tax laws and may be deductible as a non-reimbursed business expense, up to 80% of the total amount paid.

** Student or Doctoral memberships do not receive this discount.

When registering as a NCSHLA Active or Associate Member, please include the following additional information:

License Number:

When registering as a NCSHLA Associate Member, please include the following information:

Supervisor's Name: Employer/Supervisor Email Address:

When registering as a NCSHLA Student Member, please include the following information:

Program Chairperson's Name: Program Chairperson's Email:

NOTE: When registering as a NCSHLA Doctoral Member, you must provide proof of enrollment on University/Collegiate letterhead.complete and return them to the NCSHLA Central Office each year.


Highest Degree Earned
Principle Area of Practice
NCSHLA Going Green -
Recieve Communique'
by Email-Only




Sex

Female
Male
Race/Ethnicity


Do you offer bilingual services?



Yes
No
Enter Languages Supported:

American Speech Language Hearing Association (ASHA) Affiliation


ASHA Certificate of Clinical Competance

American Academy of Audiology (AAA) Affiliation

Do you wish to become a member of the NC AAA chapter (no additional charge) Yes
No

Are you licensed by the NC Board of Examiners (including temporary) Yes
No

Are you registered by the NC Board of Examiners as an SLP Assistant? Yes
No

Are you licensed by the NC Hearing Aid Dealers and Fitters Board? Yes
No

Are you certified by the NC Department of Public Instruction? Yes
No

Please indicate the type of 'umbrella agency' that establishes policy for your work setting.
State Department other than Department of Public Instruction
State Department of Public Instruction
Federal Agency, including Veterans Affairs, Head Start, ect.
County/City agency, including health departments, public hospitals, etc.
Private, including small/large practices, institutions, hospitals.
Student
University, college or community college

Indicate Your Method of Payment
Credit Card Info
Card Type: Visa  MasterCard
Exact Name on Card:
First Name:    Last Name:
Card Number

Exp. Date:


Billing Address:

Billing City

Billing State

Billing Zip


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Last update on: 7/14/2010