Arkansas Speech-Language-Hearing Association

Arkansas Speech-Language-Hearing Assoc. Membership App.
  1. Membership dues are not deductible as charitable contributions for federal income tax purposes. In addition 15 % of your dues spent for governmental relations are not deductible as a business expense.
  2. First Name(*)
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  3. Middle Name
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  4. Last Name(*)
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  5. Recruited or Referred by
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  6. Membership Categories




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  7. Renewing Member Late Fee(*)
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  8. Credit Card Convenience fee
    $3 Credit Card Convenience Fee
  9. Total
    $0.00

  10. Former Student Members will receive a 10.00 discount on initial Full member dues provided they have current student membership status when they apply.
  11. SLP/AUD # (students put 0)(*)
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  12. Home Address
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  13. City
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  14. State
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  15. Zip
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  16. Home Phone
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  17. Email Address(*)
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  18. Work Setting (check all that apply)
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  19. Place of Employment
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  20. Address
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  21. City
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  22. State
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  23. Zip
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  24. County
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  25. Work Phone
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  26. Fax
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  27. Full & Associate Members:
  28. Academic Degree
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  29. Year
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  30. Institution
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  31. Certification/Licensure (check all that apply)
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  32. Student Members:
  33. I am currently a full-time undergraduate/graduate (circle one) student at:
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  34. Estimated Date of Graduation:
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  35. Name of Program Chair or Advisor:
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  36. * 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.