ALTA - Academic Language Therapy Association

Member Application - Trainee Affiliate

The membership year begins on March 1st of each year. Membership fees received after November 1, 2018 will apply to the 2019-2020 membership year.

Member Type: Trainee Affiliate
Dues: Membership dues for Student Affiliate are $35 annually.
ALTA® dues are not deductible as a charitable contribution for federal income tax purposes, but may be deductible under other sections of the Internal Revenue Code. ALTA® estimates that 20% of your dues are not deductible because of ALTA's lobbying activities on behalf of its members. Please contact your accountant for additional tax advice.

Contact Information

First Name:
Informal Name:
Your Informal Name is how you would like your name to appear on event name badges and such.
Middle Name:
Last Name:
Address:
City:
State / Province:
Zip:
Country:
All membership fees will be charged in US Dollars regardless of your Country.
Home Phone:
(###) ###-#### Format
Mobile:
(###) ###-#### Format
Fax:
(###) ###-#### Format
Email Address:
This is the email address which ALTA will use to correspond with you and which you will use to login to the ALTA website.
Web Password:
Only alphanumeric characters please. Your password should be between 7-15 characters.

Training Center

After clicking Next Step below, you will be directed to print a form that your Training Center Program Director will need to sign. Instructions for returning this form to ALTA will be included on the form. Your membership will be provisional until this form is received.

Name of Training Center Attending:
Date Training Began:
Please enter in MM/DD/YYYY format.
Expected Graduation Date:
Please enter in MM/DD/YYYY format.

Please affirm the following statements with your signature.

I attest that the information provided in this form is true and accurate to the best of my knowledge.

I understand that membership in ALTA at the student affiliate level entitles me to access to the "members only" area of the ALTA website. I will not be listed in the ALTA directory until I become a member at the CALP or CALT level.

I understand that membership in ALTA obligates me to follow the organization's Code of Ethics. I have read and agree to adhere to ALTA's Code of Ethics if granted membership in the organization.

I understand that I must represent myself solely as an ALTA Trainee Affiliate until successfully fulfilling the requirements and applying for CALP/CALT membership.

Electronic Signature:
Please type your First and Last Name exactly as they appear at the top of this application. This will serve as your electronic signature.

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