WHS Membership/Renewal Application

WHS Membership/Renewal Application
Contact Information
Full Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
HAS/AUD License # (if student, type "Student")*
Membership Categories Defined

Voting Class. Any WA State licensed professional in good standing and who holds a valid WA state license as a Hearing Aid Specialist or Audiologist. $150 Annual Membership Fee*

Associate Class (Regular). Includes Out-of-State HIS’s or Audiologists; WA business owners; manufacturers or their representatives doing business in WA; Employees of a WA state hearing aid company. $100 Annual Membership Fee*

Associate Class (Student). Students enrolled in WA State hearing healthcare training, education including colleges and universities, and the WHS HAST program. $35 Annual Membership Fee*

Sustaining Class. Any individual or business entity that chooses to make a significant gift to the Society. Sustaining member designation is determined by a vote of the WHS membership.
Annual Fees

Registration*

Voting Member

$150.00

Associate Member

$100.00

Associate Student

$35.00

Sustaining

$ Free

Enter coupon

Total

$0.00

Certification Application
I certify that I am not under investigation by the WA Dept. of Health nor do I have any formal statement of charges pending by any regulatory agency. I agree to uphold the International Hearing Society’s Code of Ethics.*
Signature

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