Rhode Island Speech-Language-Hearing Association

Contact Information:
PO Box 9241
Providence, RI 02940

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Membership Application
2012 RISHA MEMBERSHIP APPLICATION
Valid 1/1/2012 - 12/31/2012

$50 Active Member Voting member-Master's degree or higher in SLP or AUD
$45 Associate Member Non-voting member-Bachelor's degree in SLP or AUD or individuals with a professional interest
$10 Student Member Non-voting member-Actively pursuing college/university training in SLP or AUD

Payment
Payments made via Payment Button - We Accept Visa, MasterCard, PayPal
Payments made via check - Please mail your check to:
RISHA
P.O. Box 9241
Providence, RI 02940
Once payment is made, please fill in the below application and hit submit.

Application

Name
Address
Phone
Email
Employer
Employer Address
Work Phone
Occupation/Title
Area of Interest/Specialty
Highest Degree/Where
Dept. of Health License	Yes No
Dept. of Ed. Certificate	Yes No
ASHA Certification	CCC-CF CCC-SLP CCC-AUD
ASHA Member	Yes No
Type of RISHA membership you are applying for	Active Associate Student
If Student, attending school
Membership Categories
$50 Active Member ($45 if postmarked by 12/31/11) Voting member-Master's degree or higher in SLP or AUD $45 Associate Member ($40 if postmarked by 12/31/11) Non-voting member-Bachelor's degree in SLP or AUD or individuals with a professional interest $10 Student Member Non-voting member-Actively pursuing college/university training in SLP or AUD