2021 - IHS Membership Form

Thank you for applying for IHS membership!

IHS Membership runs on the calendar year, January through December, no matter what time you join. But we have a special offer for our new members who join through this form to receive up to four months of membership FREE! That means your membership won't expire until Dec. 31, 2021.

Before you provide any contact or payment information, we ask that you answer a few key questions so that we may guide you to the best form you should use for your application.

If you have any questions about your IHS membership or this form, please email us at membership@ihsinfo.org, or call us at 734.522.7200 and ask for Membership Staff to assist you.

Let's begin!

Do you live or work outside of the US and Canada? *

Yes No

In which country do you live or practice? *

United States Canada

Are you a fully licensed hearing aid specialist or audiologist? *

Yes No

Are you a licensed practitioner working for a Miracle-Ear franchise? *

Yes No

If you are a licensed professional in the US, you may take advantage of our installment payment plan and pay quarterly. We are currently waiving the $10 installment fee. Would you like to pay by installment?

Yes No

Got it! Please continue with the form below. If you have any difficulty or questions while filling out the form, please let us know at membership@ihsinfo.org or 734.522.7200.

Great! It appears you qualify for an International Membership. Please continue the membership process by filling out the form below.

Thank you for clarifying that you work or reside in Canada. Please visit our IHS/CHIPS membership form here for Canadians to continue your membership application. If you have any questions, you may contact IHS at 734.522.7200 or membership@ihsinfo.org.

Thank you for clarifying that you are a licensed practitioner working for a Miracle-Ear franchise. Please continue your renewal using this form.

Thank you for clarifying that you work or reside in the United States but are not a licensed professional with Miracle-Ear nor do you wish to use the installment payment plan. Please continue with your renewal below.

Sounds good! To pay by installment, please email us at membership@ihsinfo.org and we will contact you to set up a plan. You may also call us at 734.522.7200 and choose the option to reach Esther Waldman, our Membership Specialist.

Name *

First Name Middle Name Last Name

List any credentials that apply (i.e., ACA, BC-HIS, etc.)

Company/Business Name

Company/Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

At which address/phone would you prefer we contact you or send you mail? *

My work My home

Work Phone Number

Area Code Phone Number

Work Fax Number

Area Code Phone Number

Home Phone Number

Area Code Phone Number

Cell Phone Number *

Area Code Phone Number

Receive Text Message Updates from IHS *

Yes, I'd like to receive Text Message (SMS/MMS) Member Updates from IHS! No thanks.

E-mail Address *

Website Address

Last 4 digits of SS/SI number (used only to match you in the database) *

Are you *

A business owner An employee

Do you train apprentices? *

Yes No

How many offices does your company have? *

How many dispensers does your company have? *

What year did you start dispensing, if applicable? *

Please type "I am not a dispenser" if this does not apply to you

What is your highest level of education? *

What is the name of the institution where you received your highest level of education?

Are you currently enrolled in a college program? *

Yes No

Please list the institution name, program, and anticipated graduation date

Gender

Male Female

Birthdate - We love to send birthday cards!

Month Day Year

In what states or provinces are you licensed to dispense hearing aids? Please list the state and your licensing number. *

If you are not licensed, please type "Not Licensed" in the field above.

Are you a military veteran? *

Yes No

In which branch did you serve?

Which title below best describes you? *

Is this a second career for you (you've switched careers or retired from a previous profession)? *

Yes No

What was your previous profession?

Members receive The Hearing Professional magazine from IHS. Please choose your preferred method of receiving THP magazine:

I prefer to read it online only. Do not send a paper copy. I prefer to receive a paper copy in the mail.

Do you have a membership promo or referral code? If so, please enter it below:

You're almost done! By completing this form you warrant that the information provided is true and accurate to the best of your knowledge. Upon IHS acceptance and processing of your application, you agree to abide by the Bylaws and Code of Ethics of the International Hearing Society. *

I acknowledge and agree to the above statement.

By submission of this form, you are providing your express consent that the International Hearing Society may retain your information in our database and other data systems, and that we may contact you via any of the contact information you provided, including but not limited to email, postal mail, or phone. Our members may also be contacted by third parties such as IHS chapters, advertising or other affiliated partners from time to time. To opt out of inclusion in third-party lists, you must send your request to be excluded to interact@ihsinfo.org *

I acknowledge and agree to the above statement.

Your Membership Category Choices:

Professional (U.S.): Individuals engaged in the practice of testing human hearing and selecting fitting, counseling patients and dispensing hearing instruments. If you are licensed, you should choose this category.
International: Those professionals employed outside the United States or Canada.
Affiliate/Associate: Office staff, receptionists or any other support staff, educators, physicians, counselors or those employed by a hearing industry manufacturer or supplier. Trainees who are not fully licensed and are no longer enrolled in college or who have completed the IHS Distance Learning Program, may choose this category.
Student: Individuals pursuing an academic or vocationally-based program of study in the practice of hearing instrument sciences or other related professions.
Inactive: Fully retired from the profession (not working part-time)

Choose Your Membership Category and Optional Advocacy Donation (fees shown in US currency): *

Professional Membership

$ 325.00

International Membership

$ 135.00

Affiliate/Associate Membership

$ 55.00

Student Membership

$ 40.00

Inactive Membership (Fully retired only)

$ 35.00

Advocacy Donation

$ 100.00

Advocacy Donation

$ 25.00

Total

$ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country