Skip to content. | Skip to navigation

Sections
Personal tools
You are here: Home → Membership → Membership Application Form 2012
NZ STA

Membership Application Form 2012

Calendar

Dates for professional development, meetings, and events

 

Membership Application Form 2012

For those wishing to renew their 2011 NZSTA membership, go here If you would like to join as a student member of NZSTA go here

 

(Required)
First name and surname
(Required)


Please include any previous surname your membership might have been recorded under.
(Required)
(Required)
(Required)
Please enter the email address you would like to receive NZSTA updates at. If you do not have a current email address, please enter "none".
(Required)


Select as many options below as apply.
(Required)
If you are currently not working please indicate this as appropriate.
(Required)
Select as many options below as apply.
(Required)
For each SLT qualification attained please list the year achieved, the name of the qualification, and the training institution. e.g. 2007 BSLT, University of Canterbury
We rquire a copy of your SLT Qualification/s (does not have to be certified copy) please either upload it here or post a copy.
(Required)


Please provide an up-to-date curriculum vitae which includes work history as an SLT and professional development completed in recent years.
(Required)


(Required)
Please indicate how you would like to receive Communication Matters in the future. Hard copies will continue to be sent out for 2012. Advantages to receiving them on-line are reduced costs to the Association, environmentally friendly, and the ability to do an electronic search for a specific topic. Back issues are available on the website.



(Required)
Please indicate how you would like to receive the Journal. Advantages to receiving it on-line are reduced costs to the association, environmentally friendly, and the ability to do an electronic search for a specific topic. Back issues are available on the website.



(Required)
Please indicate if you are interested in using the Resource Library (Members no longer need to pay an annual joining fee - however, other usage costs will still apply)


(Required)
Would you like to be included on an on-line membership list available to members only? This would include your name, membership category, region and e-mail address. There will be restrictions placed on how the information is used by members.



Please list any of particular areas of interest (related to speech-language therapy).
(Required)
A. I have read and understand the NZSTA Code of Ethics (2008) and I agree to abide by this Code and any subsequent amendments. I understand that, should I cease to be a member, any complaint against me may be directed to the Health and Disability Commissioner for investigation. B. I agree to abide by all standards required to maintain membership and I understand that, once I receive membership, my membership status may be made available to the public. C. I declare that the information provided in this form, and all other relevant documentation provided, is true and correct.
(Required)
Have you ever been disciplined or sanctioned, or are there any disciplinary proceedings pending against you before any professional association, professional licensing authority or board, or other professional regulatory body? If yes", please send details to the Executive Officer.


(Required)
Have you ever been convicted of a criminal offence or an offence related to the practice of speech-language therapy? If "yes", please send details to the Executive Officer.


(Required)
Have you been the subject of a finding of professional misconduct, incompetence or incapacity by your employer or any other body? If "yes" please send details to the Executive Officer.


(Required)
Please select the appropriate category. Please go to membership categories for more information.





(Required)
I hereby declare that I am working the following hours as a speech-language therapist and I agree to notify NZSTA in writing of any increase in hours which would take me into the higher category.



(Required)
I hereby declare that I have worked more than 1,000 hours in the past five years as a speech-language therapist which is a requirement to maintain full membership.



(Required)
I understand that to maintain full membership I must complete a CPD form at the end of 2012 and continue to meet the requirements of continuing professional development


(Required)
Please indicate your payment method by checking one of the boxes below. When making an electronic or direct payment, please use either your full name or membership number or "NZSTA Membership" as the reference.




If you have selected "electronic or direct payment" as your payment method, please indicate the date on which the payment has been / will be made.
New Zealand Speech-language Therapists' Association P O Box 137 256 Parnell Auckland
Any message you would like to include with your form

Payment by Credit Card

To make payment for the full amount by credit card on-line please go to the secure page here and follow the instructions to make a 'one-off payment'.  

 

Information required to make a credit card payment:

  • Reference - your full name 
  • Particulars - your membership number or 'NZSTA membership'
  • Amount - please make note of the amount due from above. 

When entering your credit number please do so with no spaces between the numbers.

Please note that at present we are unable to accept payment by some overseas issued credit cards.

 

Before an application for membership with the NZSTA can be considered, all documentation and payment must be received. 

The address to send documentation and payment to, if not completed on-line is:

NZSTA

PO Box 137 256

Parnell, Auckland 1151

 

 Forums Forums

Members' usernames are comprised of their initials (in capitals) followed immediately by their membership number

Member's Area


Forgot your password?
 
Web Design: MetaSolutions -- Web & CMS Development: TheVirtual Ltd.