Directory  |  Calendar  |  Forms  |  Contact Us  |  Login

Tinnitus Care Provider Certificate Program

Registration



Please fill the information below
Membership: IHS Member
I am not an IHS member but would like to join
Prefix: * Mr Mrs Ms Dr.
First Name: *
Middle Initial:
Last Name: *
Credentials (ACA, BC-HIS, PhD etc.):
Job Title: *
(Choose all that apply)

Owner/President/CEO
Hearing Aid Specialist
Audiologist
Spouse/Guest
Trainee
Account/Sales Representative
Marketing
Operations
Other
Company: *
Street Address: *
Street Address (2):
Mail Stop/P.O. Box:
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Phone: *
Format: (---)---.----
Fax:
Format: (---)---.----
Cell:
Format: (---)---.----
E-mail: *
Company Website:
Birth Date:
Format: MM/DD/YYYY
License Number
License State/Province
Format: MM/DD/YYYY
Date the license was issued
Last 4 digits of Social Number
Gender Male Female
What is the highest academic level you   
have earned?
High School Diploma or GED
Some college
Trade School
Associate's degree
Bachelor's degree
Master of Arts degree
Master of Science degree
MBA
PhD
AuD
MD
None
Other
Which industry specific organizations
are you affiliated with?
(Choose all that apply)

International Hearing Society (IHS)
Academy of Doctors of Audiology (ADA)
American Academy of Audiology (AAA)
American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS)
American Speech-Language-Hearing Association (ASHA)
Canadian Hearing Instrument Practitioners Society (CHIPS)
Local IHS Chapter - State/Provincial Association
Other
Have you served in the U.S. military?

Yes No

If yes, which branch:
AirForce
Army
Coast Guard
Marines
Merchant Marines
National Guard
Navy
Reserves


Registration Fees
Fees Amount
before August 31
Amount
IHS Member Price $1,695 USD $1,795 USD
IHS Non-Member Price $2,225 USD $2,225 USD
Join IHS & Register – Save $ Now! $2,020 USD $2,120 USD

* An additional assessment fee of $300 USD is paid at the time the candidate makes the examination appointment


Payment Method:
Choose your method of payment Visa MasterCard American Express Discover
Name on Card *
Card Number *
Expiration Date *
Security Code *


Upon successful completion of the program, I agree that IHS may list my name publicly in a directory on an IHS webpage and through various IHS publications congratulating new certificate holders.
Yes No *



Registration Policies:
  • The registration fee includes the two-day workshop, the participant guide, pre-work assignments, Dr. Tyler’s books, titled “Tinnitus Treatment: Clinical Protocols” and "The Consumer Handbook on Tinnitus”, two meals, one reception, and certificate of completion. The assessment fee is paid separately when making the examination appointment. The assessment must be taken within 30 days after the workshop.
  • Refund Policy: A refund minus a $50 processing fee will be granted to cancellation requests made by September 30, 2017. A refund minus a $100 processing fee will be granted to cancellation requests made between October 16 - November 10, 2017. No refunds will be granted after November 10, 2017. A substitute may attend.
  • Cancellation Policy: To be valid, IHS must receive notification of our cancellation in writing. Cancellations received on our before September 30, 2017 will be refunded less a $50 administrative charge; between October 16 - November 10, a refund less a $100 administrative charge. Beginning November 11, no refund is given. A substitute may attend.
  • Special Accommodations: If you require a special accommodation to fully participate, please contact IHS at 734.522.7200.


IHS
16800 Middlebelt Road, Suite 4
Livonia, MI 48154
(734)522-7200


More Info
General Information
How the Course Works
Registration
Fees
Mission Statement
Vision Statement
Curriculum
Accreditation & Continuing Education
Workshop Agenda
Hotel & Transportation
Workshop Location Requests
Exam Testing Center Locations
Candidate Registry