Online Membership Application

Aphasiology Association of Ohio Membership

This is a replica of the mail-in Application Form used exclusively in the past. You are encouraged to complete the form and submit it via the submit button at the bottom of the page. You should later send the appropriate amount via check to the address listed. If payment is not received in 14 days, you will be billed for the amount at the address you provide in your online application.

Name: Date:

Home Address(Street):

Home Address(City, State, Zip):

Home Phone:

Fax Number Used:

Email Address:

Employer Name:

Employer: Address (Street)

Employer Address(City, State, Zip):

County of Residence (Will determine which of the 5 AAO areas you reside):

Supporting File Data:

Membership Class: (scroll down & select)

Membership Fees: Regular, Associate = $25.00
                 Student            = $15.00

Work Settings: (check all that apply)

Community Center Hospital Rehabilitation/VA Center University

Home Health/Health Dept Nursing Home Private Practice

Other

Position (check all that apply)

Speech-Language Pathologist Audiologist Administrator/Speech & Hearing ConsumerStudent (indicate university) Professor/Instructor Other

Credentials (check all that apply):

CCC-SLP CCC-Audiologist Certificate-Pub School Licensed Ohio SLPLicensed Ohio Audiologist

State License Number:

Highest Degree: (scroll down & select)

Other Memberships/Credentials: (check all that apply)

ASHA

OSLHA

Regional State Speech-Language Assn.

Other Write name(s):

Areas of Interest for AAO Participation: (check all of interest)

Creating and mailing flyers to publicize association events.

Maintaining the Association's Web page

Maintain tbe Association's membership list by sending out renewals, receiving new member's forms, printing labels from the membership data base and updating the membership data base via computer.

Recommend speakers, plan and coordinate details for our annual fall workshop.

Work with new members/ welcome and introduce to participation in AAO

Work with univesity faculty and graduate students; recruit their membership and participation in continuing education programs.

Work with educational resources of the Association: maintain the collection, mail requested items to members for their continuing education and inservice needs.

Edit. write, solicit articles for and disseminate the Association Newsletter.

Represent AAO to members in your area of the state

Represent AAO in Columbus at legislative events.

I have no specific area of interest but am interested in learning more about how I can help AAO.

 

Click hereto submit and send your check for membership fee to:

Melissa Price
Miami University
Dept of Speech Pathology & Audiology, Bachelor Hall Rm 23
Oxford, OH 45056-3414

For assistance write: Richard Dean - deanr@ohio.edu

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