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Alumni Membership Application
CSAP Alumni Membership Application
Eligibility
An alumnus is defined as being a Past President of a state speech‑language‑hearing association who is currently not on the state association board. Alumni membership is open to past presidents of their state association as long as they don’t rejoin their board in a president/president-elect/past president (3P) capacity. If that happens, the CSAP Alumni member must remove himself/herself from the group until they are no longer serving in a 3P capacity with their state association. Alumni members are not eligible to be an Officer, Commissioner or Committee Chair of CSAP and are not permitted to vote in CSAP elections or Business Meetings.
First and Last Name
*
Mailing Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Email
*
Phone
Noted phone above is
Home Phone
Cell Phone
Work Phone
State Association you belonged to
*
Most Recent Office Held
*
Term End Date
*
Are you currently on your state association Board of Directors
*
Yes
No
If you selected Yes above, what is your position on the board?
Are you planning to attend either of the 2021 CSAP Conferences?
Both Spring and Fall Conferences
Spring only (Richmond, VA)
Fall only (Washington, DC)
I cannot attend either Conferences this year
Payment Information
Payment - $25
*
Alumni Membership: $25 annually
Check (Payable to CSAP. Mail to 700 McKnight Park Drive, Suite 708, Pittsburgh, PA 15237)
Credit Card (Visa, MasterCard, Discover, American Express)
Credit Card Number
Expiration Month
SELECT
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Year
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2021
2022
2023
2024
2025
2026
2027
Verification
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