Member Application

After applications are submitted, the membership committee will review monthly and send to the executive board for final approval. Once membership is approved and added to the membership database, you will receive your membership certificate. All new members from the year will be announced at the annual SENTAC Meeting. You will also receive invoices for annual membership dues.

If you have any questions, please email sentac@affinity-strategies.com.

SENTAC Membership Application

Name*
First, Middle, Last, Degree
Institution*
Are you private practice?*
- yes
- no
Are you a Student, Resident or in your Fellow?
- Student
- Resident
- Fellowship
If so, please indicate year of graduation or completion of residency/fellowship:
Credentials*
General credentials for category purposes. Specifics can be entered for Professional Specialty or Certification.
Professional Specialty*
Certification*
(e.g. ASHA, ABO. If none, so state. Not required for Associate. If your profession has no certification, note "not applicable" and provide a brief explanation below.)
Explanation
(If applicable)
Home Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone*
Fax
Please select how you identify yourself (select all that apply)
Gender not listed above:
Which of the following best describes you (select all that apply):
I would like to include a race/ethnicity not included above:
Your Email*
This is the email address you would like all membership emails to be sent to, including invoices, event information, etc.
Enter Email Confirm Email
Secondary Email
Enter Email Confirm Email
Endorsement: Name and email*
Your application must be endorsed by two member persons. These should be Fellows of the Society, unless you are not known to two Fellows. In that case, you may substitute any colleagues who can attest to your professional interests.
Email
Email
Endorsement: Name and Email*
Email
Email
Current Curriculum Vitae*
Application for membership must be accompanied by a current curriculum vitae. Upload your current CV here.
Drop files here or

Max. file size: 100 MB.
Discount Code
Hidden
Untitled
Phone
This field is for validation purposes and should be left unchanged.