CSULA NSSLHA Spring 2024 Membership Form
Please fill out this form to become a member of the NSSLHA Chapter at CSULA! If you have any questions or concerns, you may email us at csulacomd@gmail.com.
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What is your first and last name? *
What is your CalStateLA email? *
Please type the full email address.
What is your preferred email? *
Please type the full email address, even if it is your CalStateLA email.
What is your anticipated graduation date? *
Please select one of the following: *
Are you a new member or returning member? *
Have you paid your dues ($20) for the SPRING semester? *
If you have not paid dues yet, you will receive instructions to do so after you submit this form.
I am interested in and/or would like more information about...
Select all that apply.
Media Release: I hereby authorize the National Student Speech Language Hearing Association (NSSLHA) at CSULA to use, reproduce and/or publish photographs and/or video that may pertain to me- including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors. This material may also appear on the organization’s website, YouTube page and social media accounts. This authorization is continuous and may only be withdrawn by my specific recission of this authorization. *
Electronic signature *
Please type your full name.
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