Membership Type *
$325 - Professional (U.S.)
$135 - Professional (International)
$55 - U.S. Associate/Affiliate
$40 - Student
Promo Code
If you have a promo code, enter it below. Staff will check validity of promo code upon receiving your application:
Payment Method *
Visa
MasterCard
American Express
Discover
Name on Card
Card Number
Expiration Date
Security Code
Contact Info
Name (First, Middle, Last) *
Date of Birth (mm/dd/yy)
Gender
Male
Female
Last Four Digits of SS/SI Number
Home Address
Address
City
State/Province
Zip/Postal Code
Country
Phone
Business Address
Company Name
I am...
an Employee
the Business Owner
Number of offices:
Number of dispensers:
Do you train apprentices?
Yes
No
Address line 1
Address line 2
City
State/Province
Zip/Postal Code
Country
Phone
Fax
Email *
Website
What is Your Preferred Mailing Address? *
Business
Home
Professional Info
Which title best describes you? *
Audiology Assistant
Audiologist
Consultant (Not a Dispenser)
ENT
Hearing Aid Specialist
Manufacturer
Office Staff
Professor
Educator
Other
Is this a second career for you or have you switched careers or retired from a previous profession?
Yes
No
If so, what was your previous profession?
I am licensed/qualified to dispense hearing instruments in the following states/provinces/countries:
My license/registration number is:
I began dispensing hearing instruments in (year):
Education
Education Level *
Associate Applied Sciences
Associate of Arts Degree
Associate Science Degree
Bachelor Degree
High School
Licensed Practical Nurse
Master of Arts Degree
Master of Science Degree
MBA
Medical Doctor
Other
Ph.D
Some College
Trade School
Name of Institution
If currently a student, program and anticipated licensing date
Advocacy
The IHS Advocacy Alliance funds legislative and regulatory efforts on behalf of the membership. To contribute, check the box that indicates your level of support.
$25
$50
$100
$250
Other Amount - please specify below
Terms and Conditions
I agree to abide by the Bylaws and Code of Ethics of the International Hearing Society.
Do you agree with these terms?
Yes
No
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