Registration Form

Name _____________________________________________________________________Office Name or Practice __________________________________

Address__________________________________________________

Phone___________________________________________________

REQUIRED****   EMAIL ADDRESS ________________________

HA# ________________________    AU #______________________

PLEASE CHOOSE ONE OPTION:

1.  Option 1; Full 12 Hour Course (12 HADEC CEUs/ or 12 SLB CEUs; 6 audiology and 6 hearing aid hours.)  Friday and Saturday attendance required. .....................................................................................................................$285.00

2.  Option 2; 9 Hour Course (9 HADEC hours or 4 SLB Hearing aid hours and 5 Diagnostic Hours).  Saturday attendance only...$185.00

3.  Option 3: 3 Hour Course 3 CEUs. Friday attendance only...$100.00

AMOUNT ENCLOSED......................................................................................__________

Mail registration form and payment to;

Seminars in Hearing

P.O. BOX 221346

Newhall, CA 91322