PENNSYLVANIA
 SPEECH-LANGUAGE-HEARING ASSOCIATION
 

PSHA MEMBERSHIP FORM

The following on-line membership  is to be used only if credit card payment is provided.

This is a

For renewals, PSHA Membership Number: 

CONTACT  INFORMATION

First Name:  Middle  Name:  Last Name: 

Credentials: 

Street Address: 

City:    State:    Zip: 

e-mail: 

Add my email to the PSHA Listserv

Home Phone:   Work Phone:    

 Fax: 

County employed in: 

Current Employer: 

Position: 

PA License:           

Highest Degree Earned: 

Student Membership Information
Are you a Member of NSSLHA?

University Name:

PSHA is "Going Green"
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PSHA Referral Database
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Membership:

Professional/Provisional
Professional members must hold a graduate degree with major emphasis in speech-language pathology, audiology or speech, language or hearing science; or a graduate degree and present evidence of active research, interest and performance in the field of human communication. 
Provisional professional members must hold a Baccalaureate degree in Speech‑Language Pathology, Audiology or Education of the Hearing Impaired		  
Recent Graduate
An individual who has completed a graduate program within the past year.  
Student/Associate
Student members must be enrolled as a full‑time student pursuing a Baccalaureate or Masters degree or the Doctorate in Speech‑Language Pathology, Audiology, or Education of the Hearing Impaired.
Associate Members are individuals having an interest in the objectives of this organization may elect to become Associate members of this Association.  		 
 

Method of Payment:

    Credit Card Number Expiration Date month year
Enter your credit card 16 digit number without hyphens or spaces (example: 1234567891234567)