North Eastern Speech and Language Therapists Association
APPLICATION FOR MEMBERSHIP
1. Professional Membership (SLTs, Teachers, Educational Psychologists) ...............................................................................£12
2. Associate Membership (SLT Assistants / Classroom Assistants, Nursery Nurses, Early Years Practitioners and Students) .......£4
Membership runs from 1st April - 31st March. If you wish to join, your form must be returned before 31st March.
Membership forms will not be accepted at any other time of the year unless -
you are a new graduate or returning to work.
Membership will then be £1 for each month of the NESTA year.
Please complete and detach the slip below and send it with your fee and any suggestions for future topics or courses
to your NESTA Representative or return directly to NESTA Vice Treasurer: Rachel Leisk, Speech and Language Therapy Dept,
North Tyneside Gen Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH
Please make cheques payable to NESTA with your name and address on the back.
".......................................................................................................................................................................................................................................
NAME (BLOCK CAPITALS):
....................................................................................................................................................................................WORK ADDRESS
: .........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
WORK TEL NO: ......................................................................................................................................................................................................
E-MAIL ADDRESS: .................................................................................................................................................................................................
PROFESSION: .......................................................................................................................................................................................................
EMPLOYER: ..........................................................................................................................................................................................................
NESTA REP: .........................................................................................................................................................................................................
Delete as appropriate - FULL / ASSOCIATE / STUDENT - Tick if in final year [ ]
Please tick box if you were a member 09/10 [ ] Membership No: ......................................
Fee enclosed £ .............
Signature ....................................................................
Date ..............................2010