Alabama Society of Hearing Healthcare Providers & Georgia Society of Hearing Professionals Summer Meeting Registration Form
Name
*
First Name
Last Name
Designation(s) (ex., ACA, AuD, BC-HIS)
Your Name as it Should Appear on Badge
*
E-mail
*
Business Name
*
Business Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Work Number
*
-
Area Code
Phone Number
Home Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Home Number
-
Area Code
Phone Number
How did you hear about the conference?
Do you have special dietary needs? If so, what are they?
I am interested in attending the Practice Managers and Owners Special BOOTCAMP
Yes
Please Select a Registration Level
*
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Alabama/Georgia Society Member
$
325.00
Includes all CEUs and social activities.
NON Chapter Members
$
375.00
Includes all CEUs and social activities
Additional Social Package
$
125.00
Includes breakfast Saturday & Sunday and Lunch Saturday
Manufacturer Exhibitor
$
500.00
Includes table, and social events
Total
$
0.00
Submit Registration
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