(*) indicates required fields.
ASSOCIATE (after April 1) $48.75
REGULAR (after April 1) $60.00
STUDENT (after April 1) $20.00
2ND Quarter:After April 1
3RD Quarter: After July 1
4TH Quarter: After October 1 (includes next year)
COMPAC: The NYSSLHA COMPAC (Communications Political Action Committee) collects voluntary contributions and donates them on behalf of the association’s members to pro NYSSLHA candidates for state office such as State Legislators and the Governor. The COMPAC provides NYSSLHA with the financial resources to represent and lobby for the professions and individuals with communication disabilities to the key decision makers on programs like Early Intervention and Medicaid/Medicare. A minimum contribution of $20 is recommended.
Enter Contribution Amount:  (Numbers Only)
Prefix: *First Name: Mi:
 
*Last Name: Suffix:  
 
*Web site Login (Password):
Home Address:
*Address 1:
Address 2:
*City: *State:  *Zip:  -
*County:
*Home Phone:
Employment Information:
*Business Name:
Title/Position:
*Address 1:
Address 2:
*City: *State: *Zip:  
*Email:
*Business Phone:
Fax:
Protect my name from release to commercial mailing lists? Yes No
Preferred Mailing Address: Business Home
Preferred Directory: Business Home