Non Member Application

Please use this form if you would like to be a part of the Florida Hearing Society community without the benefits of full membership. If you need CEUs then you will need to become a full member by filling out this application and paying for your membership. This registration allows any hearing healthcare professional, related professionals and staff to join our website community.

* First

* Last

* Mobile Phone This is for us to reach you, it is not public.

* Company

* Business Address

* Business City

* Business State

* Business Zip

* County Location of Office This is the County of which your office is located. Your primary location of your business address.

* Business Phone

* Business Email

* Mailing Address The mailing address is not shared with the public.

* Mailing City

* Mailing State

* Mailing Zip

License Number, if Applicable Non Member accounts do not require a license but if you have one, please provide.

Anniversary Date of License, if applicable This is the date you first received your license.

Please select licenses and/or credentials, if applicable

Audioprosthology (ACA)
Board Certified Hearing Instrument Specialist (BC-HIS)
Certificate of Clinical Competency in Audiology (CCC-A)
Certified Dementia Practitioner (CDP)
Doctor of Audiology (Au.D.)
Doctoral Degree (Ph.D.)
Hearing Aid Specialist (HAS)
Tinnitus Certified

If you are not licensed, what is your association with the hearing industry?

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