LISHA Membership

Regular Member - Annual Regular Membership is $50

Regular Members shall be persons educated in speech science, speech-language and hearing rehabilitation and/or audiology, who meet one of the following professional standards:

1. New York State License as a Speech-Language Pathologist or Audiologist.

2. New York State Department of Education Certification as a Teacher of the Speech and Hearing Handicapped (TSHH) or Teacher of Students with Speech-Language Disabilities (TSSLD) and must hold a degree in Speech-Language Pathology and/or Audiology,

3. Clinical Certification by the American Speech-Language-Hearing Association and/or Fellow of the American Academy of Audiology

Student Member - Annual Student Membership is $25

Student Members must be undergraduates who have completed or matriculated towards a graduate degree a minimum of nine (9) semester hours in speech-language pathology, audiology, or speech-language and hearing sciences. Individuals who are qualified to become a member in any other member classification may not henceforth qualify as a Student Member.

LIFE Membership must be pre-approved by the Executive Directors. Submit proof of age 65 and 15 consecutive years membership in an email to info@lisha.org.

Membership year runs January 1st through December 31st and will not be pro-rated.

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Memberships *

Annual Regular Membership - $ 50.00

Annual Student Membership - $ 25.00

Life Member - $ 15.00

Associate Member - $ 50.00

Total Amount

Membership Registration

First Name *

Last Name *

Email *

Address (Home) *

City (Home) *

State (Home) *

Postal Code (Home) *

County

Phone (Home)

Cell Phone

Alternate Email

College Attended

Degree

Year Graduated

Work Setting

Website

Place of Employment

Company *

Title *

Address (Work)

City (Work)

Postal Code (Work)

County (Work)

Phone (Work)

Cert's/Assoc's

If not applicable enter "123"

NYS Speech License # *

NYS Audiology License # *

NYS Professional License # *

Teacher of Speech and Hearing Handicapped (TSHH)

Teacher of the Deaf

Teacher of Students with Speech or Language Disabilities (TSSLD)

American Academy of Audiology #

ASHA Member #

NYSSLHA Member #

ASHA Specialty Recognition Status

Area of ASHA Recognition

Evaluations/therapy in foreign language

Yes

No

Specify Language

Completion of Bilingual Extension Course Date

NYS Hearing Aid Dispenser #

Are You Speech Certified?

Yes

No

Are You Audiology Certified?

Yes

No

About

List in Private Practice Directory

Message from Practitioner

Speciality

Speech-Language Pathologist

Audiology

Developmental Delays

Deaf/Hard of Hearing

Practice Description

Patient Types

Adult

Child

Early Intervention

Geriatric

Private Practice

Practice Name

Practitioner Name

Address (Private Practice)

Address 2 (Private Practice)

City (Private Practice)

State (Private Practice)

Phone (Private Practice)

Website (Private Practice)

Email (Private Practice)

By proceeding, I agree to abide by the Code of Ethics (https://lisha.org/code-of-ethics-2) and Constitution of the Long Island Speech-Language-Hearing Association.(https://lisha.org/lisha-constitution)

Membership year runs January 1st through December 31st and will not be pro-rated.