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NZSTA Membership Renewal Form 2012

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NZSTA Membership Renewal Form 2012

This form is only for speech-language therapists who have been members of the NZSTA in 2011 and wish to renew their membership for 2012. 

If you have received a summary of the information held about you by the NZSTA you only need to enter the information that has changed.  Please note there are some fields and declarations which must be completed before you will be able to submit the form, these are marked by a small red square.

For student members wishing to renew their membership go here

 

(Required)
If you have previously been a member of the NZSTA under a name different to that provided above, please provide your previous name here.
(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".
Enter if changed from summary information sent to you
Enter if changed from summary information sent to you
Enter if changed from summary information sent to you
Enter if different from summary information sent to you by selecting one or more of the options below.
Enter if changed from summary information sent to you. If you are currently not working please indicate this as appropriate.
Enter if different from summary information sent to you. Mark as many as apply.
(Required)
For those in clinical practice what client groups do you work with? Select as many as applicable
Enter if different or missing from summary information sent to you. 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
If you have not previously sent 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 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 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)
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)
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.



(Required)
To help us in planning professional development a list of members prepared to give feedback on possible professional development events is valuable. You would be contacted by e-mail only as required.


What areas of interest do you have
It is a requirement to maintain full membership to complete and file your Continuing Professional Development record for 2011. Please upload it here. The link to the CPD form is available by clicking on the Membership menu - it is under the heading 'Applying for Membership or Membership Renewal'.
(Required)
Please select one of the following as appropriate.





(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 convicted of a criminal offence or an offence related to the practice of speech-language therapy? If "yes", please send details to the Administrator.


(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 Administrator.


(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 Administrator.


(Required)
Please select the appropriate category. Please go to membership categories for more information. The fees shown below are GST inclusive.






Only for new graduates in 2012 who were a student member of NZSTA in 2011. Please select the years in which you were a student member of the NZSTA. You are eligible for a discount off your provisional membership for each year of student membership.
(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 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)
Please indicate your payment method by checking one of the boxes below. Details of how to make payments will come up once the form has been submitted.





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

Details of how to make payment will come up once the form has been submitted. 

 

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