TM Application for Membership of IAA

Personal Details:

First Name: / Preferred Contact Address for Correspondences (e.g. home address, or work address):

Surname:

Tel (mobile):

Tel (work):

Fax:

E-Mail:

Home Address:

(Optional and if different

ToAbove)

Employment Details: Please enclose proof of current post held (i.e. attached letter signed by Head of Department)

Job Title: Department:

Name of employer:

Work Address:

Telephone Number to incl. ext. no.:

Brief description of work:

Employment status: Fulltime Sessional Part time Locum

Professional Details:

Yes No Reg No.

Are you registered with another registration body?

If YES, please state name of registration body…………………..

…………………………………………………………………………….

Are you interested in Active Participation by means of joining an IAA committee or subcommittee?

Yes ...... No ………

Please indicate your main area of interest?

Specify Committee(s):

QUALIFICATIONS

Professional Qualifications in Audiology (include BAAT, Dip/Cert, BSC, MSc, CAC, CtP, HCtP and dates

Attained) COPIES TO BE ATTACHED AS EVIDENCE OF ATTAINMENT.

Dates attained Qualification Awarding Body

Other related professional qualifications (to include first degree where appropriate, counselling,

Teaching, health management etc)

Dates attained Qualifications Awarding Body

Membership Category you are applying for: (please tick relevant box)

Please refer to Guidance for Membership Applications for a description of each category.


Full (€70) Affiliate/
Retiree (€50) Associate (€50) Student (€10)

Regrade from Student to Full Regrade from Full to Student
Student Membership Only:
Institute/College:
Title of Course:
Date course Commenced:
Date Course Ends:
Course Tutor:
Signature of Course Tutor:

Professional Affiliation and Interests (Optional, BUT required field if seeking Affiliate membership)

Please circle the description(s) which most closely specify your own professional affiliation and/or interests in Group A and Group B.
GROUP A
Audiological Physician / Otolaryngologist/ ENT Surgeon
Clinical Audiologist / Paediatrician
Clinical Medical Officer / Psychologist
Community Medical Officer in Audiology / Registered Hearing Aid Dispenser
Educational Audiologist / School Hearing Screener
Electrical/Electronic Engineer / NHSP Screener/Paediatric Screener
General Medical Practitioner / School Nurse
Hearing Therapist / Speech & Language Therapist
Health Nurse / Teacher of the Deaf
Industrial Audiometrician / Occupational Therapist
Medical Physicist / Teacher of Lipreading
Scientist/Acoustician (Audiology) / Social Worker
GROUP B
Academic / Private Sector
Charity Professional / Research
Hearing Impaired Person / Retired
Marketing & Sales / Student
Health Service Executive / Other (Please detail)
Relative of Hearing Impaired Person

PROOF OF CURRENT POST HELD

(Please complete in block capitals)

I ………………………………………….. as Head of Department or Line Manager

at………………………...... wish to confirm that

………………..…………………………………. is employed

in this Department as a competent clinical audiologist for ……years in the capacity of

……………………………………on a  Full time

 Sessional

 Part time

 Locum basis (tick as appropriate)

Signed:…………………………………………………….

Title:………………………………………………………..

Date:………………………

IAA MEMBERSHIP

The members of the IAA shall consist of affiliates, associates/retirees,full and student

members. Additional categories may be established by policy of the Board of Directors.

All members shall hold rights and obligations as defined by the membership categories as outlined below.

All members of IAA will abide by IAA’s established Code of Conduct and this shall be periodically

reviewed and amended by the IAA Board. Copies of the Code of Practice shall be given to all members

on their first admission as a member of the IAA.

CATEGORIES:

Associate Membership

For those applicants who are not eligible for election as Full or Affiliate members but are actively engaged as Assistant Healthcare Practitioners or equivalent in the practice of Audiology in Ireland. Associate members do not have the right to vote at the AGM and cannot hold office as an IAA Board Director.Associate members shall not use the letters MIAA or the words Member of the Irish Academy of Audiology after his/her name.

Affiliate/Retiree Membership

This is open to all applicantswho do not fulfil the Full or Student membership requirements but who have a qualification in Audiology, or a related interest, this may include commercial organisations or voluntary bodies active in the field of Audiology. Affiliate members do not have the right to vote at the AGM and cannot hold office as an IAA Board Director.Affiliate members shall not use the letters MIAA or the words Member of the Irish Academy of Audiology after his/her name.

Full Membership

Full membership of the Academy is restricted to Clinical Audiologistsworking in Irelandwho meet the criteria for entry to the full membership register maintained by the board/council.

Criteria for entry to the full membership register of Clinical Audiologists

Part 1 and part 2 of the British Association of Audiologists or its predecessor with at least two years internship post qualification.

Or A first degree in Audiology which must include evidence of a satisfactory assessment of competence

Or A post graduate diploma in Audiology and evidence of a satisfactory assessment of competence

Or An MSc in Audiology and evidence of a satisfactory assessment of competence

And Assessment of suitability for registration with the Academy.

Those individuals who are practising as Clinical Audiologists in Ireland but who do not fully meet the entry conditions for registration as full members of The Academy can be considered by the board/council under grand-parenting arrangements. These individuals may be required to provide further information/evidence and/or to attend for interview.

Full members will have the right to vote at the AGM and can hold office as an IAA Board Director.

Full members may use the letters MIAA or the words Member of the Irish Academy of Audiology after his/her name.

Student Membership

Membership as a student will be granted on the production of confirmation of registration on an IAA recognisedfull time course and will continue for the length of that course and not able to fulfil criteria for Full or Affiliate IAA membership.

IAA recognised part-time qualification in Audiology for a period of no more than 2 years, and not able to fulfil criteria for Full or Affiliate IAA membership

Student membership will last until the 1st October in the year of graduation. Affiliate membership should be taken from October 1st until such time applicant is eligible to upgrade to Full membership e.g. satisfactory assessment of competency.

It is the individual’s responsibility to ensure that they upgrade their membership as appropriate.

Student members do not have the right to vote at the AGM and cannot hold office as a IAA Board Director.

Student members shall not use the letters MIAA or the words Member of the Irish Academy of Audiology after his/her name.

Completing the Membership Application Form:

The form should be completed in ink. Please write clearly. Please forward copies of all supporting documentation (e.g. degree certificates, evidence of employment) with your application.

If your application to the Academy is successful the information contained on this form will be kept on a database in accordance with the Data Protection Act.

Completed Application Forms together with the necessary accompanying documentation should be sent with the appropriate remuneration to: Ms. Therina O’Mahony, Secretary Irish Academy of Audiology, SouthInfirmaryVictoriaUniversityHospital, Old Blackrock Road, Cork.

PLEASE NOTE: YOUR APPLICATION WILL NOT BE PROCESSED UNTIL ALL REQUIRED INFORMATION IS RECEIVED.

Make cheque payable to IAA for the full amount, writing your name on the back of the cheque.

Enquiries:

If you have any enquiries about membership of the Academy or about your membership application, please contact IAA Secretary at the address above or email o’

FOR INCLUSION WITH RENEWAL IAA APPLICATION FORMS

Guidance for IAA Membership and IAA Membership Applications:

Processing the Application:

Your application will be taken to the Board for consideration at their next meeting. Board meetings occur 4 or 5 times a year and there may be a delay of up to 3 months between receipt of the application and consideration by the Board. You will be notified in writing of the outcome of your application. Please note that entry to the Academy is at the discretion of the Board.

Half Year Subscriptions:

No longer an option. Decision voted on by IAA committee August 2013 to come into effect from calendar year 2014.

Lapsed Members: Members who have let their membership lapse and are reapplying are charged an administration fee of €10 to be reinstated on the mailing list.