Conference

ATTENDEE REGISTRATION

New Hampshire Academy of Audiology
Friday, April 27, 2018

Instructions: To register online, please fill in the form below and click the "Register!" button. On the next page, you will have an opportunity to pay online. Please note that BOLD fields are required.

NAME:
Employment Setting:
Job Title:
Mailing Address:
City:
State:
Zip:
DAYTIME PHONE:
Fax:
EMAIL:
(for confirmation notices only)
For CEUs, AAA No.
PRICE:
Advisor's Name:
University:
  I need ABA/Tier I CEUs.
  I need an assistive listening device.
  I need other special accommodations.
  (please specify:)
 

NOTE: Register and pay online by April 13th (preferred registration method, above). If you really MUST pay by mail, please print the PDF registration form and send via postal mail along with your check (payable to 'NHAA') to:

Audiology Specialists LLC
211 South Main Street
Laconia, NH 03246