Corporate Group Membership Renewal Form

The renewal page I plan to have corporate groups to use for the 2018 Renewal season.

Categories:
Membership Forms
Tags:
Shared by: ihs

Corporate Group Membership Renewal Form
Point of Contact's Name and Details
Your name *

First Name Last Name
Title
Company Name *
Cell Number

- Area Code Phone Number

Business Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

E-mail *
Business Phone *

- Area Code Phone Number
Fax Number

- Area Code Phone Number
Website
Corporate Group Membership Levels

Membership Year is January 1 through December 31
- Corporate Group Professional Membership - Individuals engaged in the practice of testing human hearing and selecting fitting, counseling patients, and dispensing hearing instruments: $260 per year
- Affiliate/Associate Membership - Office staff, receptionists or any other support staff, educators, physicians, counselors, or those employed by a hearing industry manufacturer or supplier. Also those who have completed their coursework but are still studying for the licensing exam: $55 per year
- Paid Student Membership- Individuals pursuing an academic or vocationally-based program of study in the practice of hearing instrument sciences or other related professions: $ 40 per year
- Life Member- Individuals that have achieved 40 years or more of membership with the International Hearing Society or have served in the role of IHS Board of Governors President: Complimentary
Upload Corporate Group Invoice Confirming Corporate Group Members *

Browse Files
Please be sure to add individuals to your invoice if they are joining the Corporate Group for the first time Cancel of
Upload Corporate Group Renewal Statements & New Corporate Group Member Forms *

Browse Files
Please be sure to denote any corrections to the contact information on the renewal statements Cancel of
Upload Advocacy Donation Form for Corporate Group

Browse Files
Please use this field if you or your employee members would like to make an advocacy donation. Cancel of

Specify the number of members in each category and check the box to the left

Corporate Group Professional Member $ 260.00

Quantity

Affiliate/Associate Member $ 55.00

Quantity

Premium Student Member $ 40.00

Quantity

Life Member Free

Quantity

Total $ 0.00

Credit Card Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

By submitting this Corporate Group renewal invoice and renewal statements, all renewing and new members in your group agree to abide by the Bylaws and Code of Ethics of the International Hearing Society. Do you agree with these terms?

Yes No
Should be Empty: