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Staff Recipient

Esther Waldman
membership@ihsinfo.org
734.522.7200 x223

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Joint Membership Renewal Through Dec 31, 2017

Thank you for helping us keep our records current to serve you better! Please complete the Contact Info section, then update us on any changes or new data you have this year.

 

Payment by credit card will complete your renewal at the end of this form.

Your IHS/CHIPS joint membership will be processed in US currency (USD). Should you choose not to use this form for online payment, please submit your bank draft payable in US CURRENCY, to the International Hearing Society, 16880 Middlebelt Rd., Ste. 4, Livonia, MI 48154 USA. PERSONAL CHEQUES AND ANY CHEQUE THAT IS NOT A BANK DRAFT WILL NOT BE ACCEPTED.

 

The work IHS and CHIPS does is only possible because of the dedication and loyalty of our sustaining members – we appreciate you!



* Required Info

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
Retired

Number of offices:

Number of dispensers:

Address line 1 *

Address line 2

City *

State/Province *

Zip/Postal Code *

Country *

Phone *

Fax

Email (for Listing) *

Website

If you are Retired, what date did you retire?

Preferred Mailing Address *
Business
Home


Membership Dues

Professional: Individuals engaged in the practice of testing human hearing and selecting, fitting and dispensing hearing instruments, and counseling patients.
Industrial: Individuals engaged in the hearing aid industry, but not necessarily involved in all phases of the practice of testing human hearing and selecting, fitting and/or counseling and dispensing hearing instruments.
Affiliate/Associate: Office staff, receptionists or any other support staff, educators, physicians, counselors or those employed by a hearing industry manufacturer or supplier.
Student: Individuals pursuing an academic or vocationally-based program of study in the practice of hearing instrument sciences or other related professions.

All amounts are in US currency.


$244 - Professional
$100 - Industrial
$100 - Associate/Affiliate
$40 - Student
$35 - Inactive (Retirees only)



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 (also in US currency).
$25
$50
$100
$250
Other Amount - please specify below

Other Amount for Advocacy Alliance Contribution


Payment Method

 

Your membership payment and any advocacy donations will be processed in US currency (USD).

 

Choose your method of payment
Visa
MasterCard
American Express
Discover


Name on Card

Card Number

Expiration Date

Security Code

Total Payment


Terms and Conditions

 

I agree that my membership payment will be processed in US currency (USD). I agree to abide by the Bylaws and Code of Ethics of the International Hearing Society and the Canadian Hearing Instrument Practitioners Society.

Do you agree with these terms?
Yes
No