ASHA CE Registry Application

Please print this document, fill out all required fields (marked by *) and return this form with your fees, payable in US funds, to:

Continuing Education Registry
American-Speech-Language Hearing Association
P.O. Box 1160 #340
Rockville, MD 20849

   *Name

   ________________________________________________            
    First                MI              Maiden                    Last

  *Mailing Address

  ___________________________________________
  ___________________________________________

  *Phone  _____________________________ 

  *E-mail  _____________________________

  *ASHA/NSSLHA Membership Number:

  ____________________________________________
 
  I am paying annual CE Registry fee(s) for calendar year(s):

  ________, ________, ________, _________

  ______  ASHA/NSSLHA member annual CE fee
                ($24/$25 beginning 1/1/2010)

  ______  Nonmember fee ($34/$35 beginning 1/1/2010)

$______  Total enclosed

 

Please keep the following information for your records:

Year(s) Paid  _______

Fee Paid $  ________

Check #  _________

Documenting your continuing education is as easy as 1-2-3!

  1. Complete the ASHA CE Registry subscription form above and send it, along with your payment, to the ASHA CE Registry. You will be credited with an electronic voucher to request one free transcript.

  2. Look for this logo and participate in any ASHA CE Provider' s continuing education activity (conventions, workshops, self-studies, journal studies, etc.), or develop an Independent Study through an ASHA Approved Independent Study Provider.

                   
    Ce Provider logo short


  3. Follow the instructions for earning ASHA CEUs as directed by the ASHA Approved CE Provider. After the CE Provider verifies your satisfactory completion of the course, ASHA CEUs will be awarded and recorded on your permanent ASHA CE Registry transcript

If you have questions about your CE fee or the ASHA CE Registry, please contact the CE Registry at 1-800-498-2071, ext. 8591 or e-mail continuinged@asha.org.



This page was updated on: 7/17/2009.

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