Join GO SSLP!
The GO SSLP membership year is from January 1 - December 31. Membership dues are $35.00 per year for 2009. Print this membership form and mail with your dues to Kim Jones, 5335 Terrytown Lane, Lithonia, GA 30038. Make checks payable to:
GO SSLP
Georgia Organization of School-Based Speech-Language Pathologists
Membership Form For 2009
Check one: _____new member _____ renewal
Name: ________________________________ Date: ________________
___ Check if change in name: Previous name__________________
Home Address: ___ Check if change in address
Street ________________________________________________
City: _______________________ State: ____________ Zip: ________
Phone: ___________________ Fax:_______________ email____________________
Work:
If renewal: ____ Check if change in work location
County/System:__________________________ Facility ____________________
Street: _____________________________________________________________
City: _______________________ State: ___________ Zip:________
Phone: ___________________ Fax: _______________ email: ___________________
Current position: ____________________
GLRS Region/SLP Consortium _______________________________________
_____Willing to join a committee: please list preferences from list on Committee page of website
______________________________________________________________________
The GO SSLP membership year is from January - December. Membership dues are $35.00 per year. Please make checks payable to GO SSLP and mail to : Kim Jones, 5335 Terrytown Lane, Lithonia, GA 30038
