WASHINGTON HEARING SOCIETY - Membership Renewal

Contact Information

Full Name*

Email*

Applicant Personal Information

First Name*

Address

State*

Cell Phone*

Email*

HAS/AUD License #

Last Name*

City

Zip Code*

Work Phone*

Membership Categories Defined

Voting Class. Any WA State licensed professional in good standing and who holds a valid WA state license as a Hearing Aid Specialist or Audiologist. $150 Annual Membership Fee*

Associate Class (Regular). Includes Out-of-State HIS’s or Audiologists; WA business owners; manufacturers or their representatives doing business in WA; Employees of a WA state hearing aid company. $100 Annual Membership Fee*

Associate Class (Student). Students enrolled in WA State hearing healthcare training, education including colleges and universities, and the WHS HAST program. $35 Annual Membership Fee*

Sustaining Class. Any individual or business entity that chooses to make a significant gift to the Society. Sustaining member designation is determined by a vote of the WHS membership.

Annual Fees

Select Membership Class*

Certification of Application

I certify that I am not under investigation by the WA Dept. of Health nor do I have any formal statement of charges pending by any regulatory agency. I agree to uphold the International Hearing Society’s Code of Ethics.*

Signature of Applicant

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