2022 IHS Membership Application Form

Thank you for applying for IHS membership!

IHS Membership runs on the calendar year. When you join today, your membership will be active until 12/31/2022.

Before you provide any contact or payment information, we ask that you answer a few key questions so that we may guide you to the best form you should use for your application.

If you have any questions about IHS membership or this form, please email us at membership@ihsinfo.org, or call us at 734.522.7200, option 2, for Membership Staff to assist you.

Let's begin!

Are you living or working in Canada?

Yes No

Are you a fully licensed hearing aid specialist or audiologist? *

Yes No

Are you a licensed hearing aid dispenser working for a Miracle-Ear franchise, or a Miracle-Ear franchise owner, in the US? *

Yes No

If you are a licensed dispenser, you may take advantage of our installment payment plan and pay quarterly or monthly for Professionals. OR you may utilize Auto-Renew to renew your membership in full each year. There are no extra fees for these services. Would you like to pay by installment or set up auto-renew?

Yes No

Thank you for clarifying that you live or work in Canada. Please continue your renewal using this form.

Thank you for clarifying that you are a licensed practitioner working for a Miracle-Ear franchise in the US. Please continue your application using this form.

Thank you for clarifying. Please continue with your renewal below.

Sounds good! To pay by installment or to initiate auto-renew for Professional members anywhere in the world, please use this form. If you have any questions or need assistance, email us at membership@ihsinfo.org or call us at 734.522.7200, option 3.

Got it! Please continue with the form below. If you have any difficulty or questions while filling out the form, please let us know at membership@ihsinfo.org or 734.522.7200, option 3.

Name *

First Name Middle Name Last Name

List any credentials that apply (i.e., ACA, BC-HIS, etc.)

Company/Business Name

Company/Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

At which address/phone would you prefer we contact you or send you mail? *

My work My home

Work Phone Number

Area Code Phone Number

Work Fax Number

Area Code Phone Number

Home Phone Number

Area Code Phone Number

Cell Phone Number *

Area Code Phone Number

Receive Text Message Updates from IHS *

Yes, I'd like to receive Text Message (SMS/MMS) Member Updates from IHS! No thanks.

E-mail Address *

Website Address

Last 4 digits of SS/SI number (used only to match you in the database) *

What prompted you to join IHS? *

What is the single most important thing you need solved in your business or career today?

What is the most important takeaway you need from your IHS membership?

Are you *

A business owner An employee

Do you train apprentices?

Yes No

How many offices does your company have?

How many dispensers does your company have?

What year did you start dispensing, if applicable? *

Please type "I am not a dispenser" if this does not apply to you

What is your highest level of education? *

What is the name of the institution where you received your highest level of education?

Are you currently enrolled in a college program? *

Yes No

Please list the institution name, program, and anticipated graduation date

Gender

Male Female Other or Prefer Not to Answer

Birthdate - We love to send birthday cards!

Month Day Year

In what states or provinces are you licensed to dispense hearing aids? Please list the state and your licensing number. *

If you are not licensed, please type "Not Licensed" in the field above.

Are you a military veteran?

Yes No

In which branch did you serve?

Which title below best describes you? *

Is this a second career for you (you've switched careers or retired from a previous profession)?

Yes No

What was your previous profession?

Members receive The Hearing Professional magazine from IHS. Please choose your preferred method of receiving THP magazine: *

I prefer to read it online only. Do not send a paper copy. I prefer to receive a paper copy in the mail.

Do you have a promo code?

Enter promo code here

You're almost done! By completing this form you warrant that the information provided is true and accurate to the best of your knowledge. Upon IHS acceptance and processing of your application, you agree to abide by the Bylaws and Code of Ethics of the International Hearing Society. *

I acknowledge and agree to the above statement.

By submission of this form, you are providing your express consent that the International Hearing Society may retain your information in our database and other data systems, and that we may contact you via any of the contact information you provided, including but not limited to email, postal mail, or phone. Our members may also be contacted by third parties such as IHS chapters, advertising or other affiliated partners from time to time. To opt out of inclusion in third-party lists, you must send your request to be excluded to interact@ihsinfo.org *

I acknowledge and agree to the above statement.

Your Membership Category Choices:

Professional (U.S.): Individuals engaged in the practice of testing human hearing and selecting fitting, counseling patients and dispensing hearing instruments. If you are licensed, you should choose this category.
Professional (International): Those professionals employed outside the United States.
Affiliate/Associate: Office staff, receptionists or any other support staff, educators, physicians, counselors or those employed by a hearing industry manufacturer or supplier. Trainees who are not fully licensed and are no longer enrolled in college or who have completed the IHS Distance Learning Program, may choose this category.
Student: Individuals pursuing an academic or vocationally-based program of study in the practice of hearing instrument sciences or other related professions.
Inactive: Fully retired from the profession (not working part-time)

Choose Your Membership Category and Optional Advocacy Donation (fees shown in US currency): *

Professional (US) Membership

$ 325.00

Professional (International) Membership

$ 135.00

Affiliate/Associate Membership

$ 55.00

Student Membership

$ 40.00

Inactive Membership (Fully retired only)

$ 35.00

Advocacy Donation

$ 100.00

Advocacy Donation

$ 25.00

Total

$ 0.00

Credit Card
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