2026 Membership Application for Associate Members

2026 Membership Application for Associate Members

January 1, 2026 - December 31, 2026
Associate Member: Non-Voting persons, organizations or businesses which do not directly engage in the dispensing of hearing aids but are involved in the hearing instrument industry or related hearing health care services or organizations.

An individual, corporation, firm, business, or other legal entity that is not a registered hearing aid dispenser but is solely involved in the sale of over-the-counter hearing aids, as such devices are defined in the regulations of the U.S. Food and Drug Administration, does not qualify for Associate Membership. Associate members shall not be eligible to vote, serve on the Board of Directors or hold office. They shall be eligible, however, to serve on committees, attend the annual meeting, and participate in other activities of the organization.
Application for membership as an Associate Member must include a statement from the applicant stating the following: “I am active, through my business or profession, in the hearing instrument industry or in providing related hearing health care services or products. My business or profession is...":
Business or Profession
Full Name*

First NameLast Name
Business Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Service or Product:
Other Association Memberships

IHSNYSHLAAAAASHAADAOther
Professional Degrees or Certifications:

M.S.M.A.Ph.DAu.DACACCC-AOther
BC-HIS: Please Indicate the Last 4 Digits of Your SS#*
Other NYS Licenses/Registrations:
Other States:
Please Indicate How You Would Like Your Name to Appear on Your Membership Certificate (include degree and accreditation, if desired)
Who Are Your NYS Legislators?
Use the links below to find your Senators and Assemblymembers where you live and work. This helps us focus our lobbying and legislative efforts on legislators who have HHCANY constituents.

https://www.nysenate.gov/find-my-senator

https://nyassembly.gov/mem/search/
Your Senator Where You Live:
Your Assemblymember Where You Live:
Your Senator Where you Work:
Your Assemblymember Where You Work:
2026 HHCANY Membership Dues and Voluntary PAC Contribution

New Members and Renewing 2025 Members
$150 for my 2025 Associate Member HHCANY Dues *
$150
Voluntary Contribution to The HHCANY Political Action Committee (HHCANY PAC)
$ ___________
Our PAC is funded by member contributions, and is used to support NYS legislators and the Governor to advance our legislative agenda in Albany.
Total Amount*
$ ____________
Payment:

Please SUBMIT THIS FORM below and send check payments (payable to HHCANY, Inc.) to our
NEW ADDRESS:

Hearing Health Care Alliance of New York, Inc.
130 Washington Ave.
3rd Floor North Suite A
Albany, NY 12210

NEW! Payments by Credit Card

Please FILL OUT AND SUBMIT THIS FORM and GO TO THE ONLINE STORE AT OUR WEBSITE, WWW.HHCANY.ORG, to pay with a credit card

*Please note the prices to pay by check vs. payments by credit card*
Email: hhcany@hhcany.org

Phone: 518-949-7121
Should be Empty:

2026 Membership Application for Associate Members

Who Are Your NYS Legislators?

2026 HHCANY Membership Dues and Voluntary PAC Contribution