Arkansas Speech-Language-Hearing Association

ArkSHA Membership Renewal
  1. First Name(*)
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  2. Middle Name
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  3. Last Name(*)
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  4. Membership Categories(*)




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  5. Renewing Member Late Fee
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  6. Credit Card Convenience fee
    $3 Credit Card Convenience Fee
  7. Total
    $0.00
  8. SLP/AUD # (students put 0)(*)
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  9. Home Address
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  10. City
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  11. State
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  12. Zip
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  13. Home Phone
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  14. Email Address(*)
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  15. Place of Employment
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  16. Address
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  17. City
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  18. State
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  19. Zip
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  20. Work Phone
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  21. Academic Degree
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  22. Certification/Licensure (check all that apply)
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  23. * Membership dues are not deductible as charitable contributions for federal income tax purposes. In addition 21 % of your dues spent for governmental relations are not deductible as a business expense.