OCSLHA

Oakland County Speech-Language-Hearing Association

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MEMBERSHIP FORM

To join OCSLHA print this form and mail it to the address below with your check.

NAME__________________________________________ DATE______________

STREET___________________________________________________________

CITY/ZIP_______________________________________PHONE______________

SCHOOL DISTRICT__________________________________________________

EMAIL ADDRESS___________________________________________________

How many years have you practiced? ____

Speech/Language Pathology?_____          Audiology?_____      Other?_________

How many years have you worked in Oakland County?________

What population do you service?     Early Intervention______      Preschool________

Elementary____     Middle School_____    High School_____   Other_____________

Are you ASHA certified? Yes_____ No_____

MEMBERSHIP DUES: $25.00       GRAD STUDENT DUES: $10.00
MAKE CHECKS PAYABLE TO OCSLHA
Memberships must be renewed every September.

MAIL TO: Kelly Warrick, 7037 Magnolia Lane, Waterford, MI 48327

Fill out the form below if you would like to be included in our Private Therapy list on our web site www.OCSLHA.com:
Name: District:
City of residence:
In what areas are you willing to work?
.
Specialty (age level & types of impairments): 
.
Available summers only?                 All year?
How would you like to be contacted:
Email address:                                                              Phone:
 

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This page last updated on 04/30/08

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