IHS 2025 Virtual Conference Registration

IHS 2025 Virtual Conference Registration

April 11, 2025 live via Zoom | Pay-by-Check
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Last 4 Digits of SSN*
Company Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Ticket Pricing (please select the options you are paying for)*

Member - $149.00Non-Member - $199.00n/a
Sponsorship Pricing (please select the options you are paying for)*

Platinum Sponsor (includes 3 virtual conference tickets) - $2,000.00Gold Sponsor (includes 2 virtual conference tickets) - $1,000.00Silver Sponsor (includes 1 virtual conference ticket) - $500.00n/a
Total Payment Amount:*
Check #*
Please send checks to:

Illinois Hearing Society
1 N Old State Capitol Plaza, Suite 410
Springfield, IL 62701-1368
Should be Empty: