EARLY-BIRD REGISTRATION

DEADLINE: MARCH 31, 2018

What does a General Package include?

State and Chapter Awards Reception & Ceremony, Wednesday, June 20
National Awards Breakfast & Ceremony, Thursday, June 21
Exhibit Hall Grand Opening, Thursday, June 21
Opening Session, Thursday, June 21
Get Acquainted Party (GAP), Thursday, June 21
Research Symposium, Listening in Noise, Friday, June 22
Unlimited entry to Exhibit Hall and Socials
All workshops, demo presentations and featured speakers

Select your registration package below:

EARLY-BIRD by 3.31 REGULAR by 5.31 ONSITE

Member $255 Member $315 Member $350
Member Couple/Family $399 Member Couple/Family $499 Member Couple/Family $575
Non-member $315 Non-member $389 Non-member $425
Student $140 Student $195 Student $225
Non-Member Student $175 Non-Member Student $225 Non-Member Student $250

DAILY PACKAGE by 3.31 DAILY PACKAGE by 5.31 DAILY PACKAGE ONSITE

Thursday $125 Thursday $150 Thursday $200
Friday $125 Friday $150 Friday $200
Saturday $125 Saturday $150 Saturday $200

Registration total: $_________

RSVP for events included in General Package:

State & Chapter Awards Reception & Ceremony 6/20 ____YES ____NO Extra tickets $15 x ___ $_____
National Awards Breakfast & Ceremony 6/21 ____YES ____NO Extra tickets $25 x ___ $_____
Get Acquainted Party 6/21 ____YES ____NO

Event Tickets: (Not included in the General Package)

FRIDAY, JUNE 22 SATURDAY, JUNE 23
An Evening with Mandy Harvey West Side Story at the Guthrie Theater
Member $ 45 x ____ $_____ Member $ 35 x____ $_____
Non-member $ 55 x ____ $_____ Non-member $ 45 x ____ $_____
Purchase by 3.31 to guarantee a ticket

Tickets total: $_____________

Dietary Needs:
Primary Attendee: ___ Vegetarian ____ Low Sodium ____ Diabetic ____ Gluten Free
Second Attendee: ___ Vegetarian ____ Low Sodium ____ Diabetic ____ Gluten Free
Are you a young adult (ages 18-30)?
Yes: ____ No: ____

Communication Access at HLAA2018

HLAA will continue to employ real-time captioning during every plenary session and workshop in addition to hearing loops in
all rooms. Sign language interpretation is available during plenary sessions and by request for workshops. All requests
must be sent to convention@hearingloss.org by June 1, 2018. Please see the convention page for more information.

Membership Select Membership Type

New Individual $35/1yr Couple/Family $45/1yr

Renewal Individual $95/3yr Student $20 (enclose copy of student I.D.)
Individual $140/5yr Professional $60

Membership total: $__________

Would you like to make a Contribution? Registration total: $__________
Contributions help support the information, education, support,
and advocacy efforts of HLAA throughout the year. Donors who Tickets total: $__________
contribute to the Convention will be listed in the Convention
Program if received by April 30, 2018. Contribution total: $__________

PAYMENT TOTAL: $__________

Registration Information

______________________________________________________________________________________
Primary Registrant (Name as it will appear on badge) Secondary Registrant (Name as it will appear on badge)

_______________________________________________________________________________________________
Address City State Zip Code

_______________________________________________________________________________________________
Daytime Phone Email

Payment Information
Check payable to Hearing Loss Association of America or Visa AMEX MC Discover

____________________________________ ______________ ________________

Card Number Expiration Date CSC Security Code

______________________________________________ _______________________________
Cardholders Name Cardholders Signature
_________________________________________________________________________________________________
Billing Address (If different than address above)
CANCELLATION POLICY
Mail form and payment to:
Hearing Loss Association of America
The following policy applies to refunds of registration fees:
7910 Woodmont Avenue, Suite 1200 Cancellation on/or before March 31, 2018: Refund = full amount of
Bethesda, MD 20814 registration fees and event tickets less a $50 cancellation fee.
Or, fax your form to: Cancellation between March 31 and April 30, 2018: Refund = 75% of
301.913.9413 registration fees and event tickets.
Questions? Call or email us at: Cancellation between May 1 and May 31, 2018: Refund = 50% of registration
convention@hearingloss.org fees and event tickets.
Phone 301.657.2248 No refunds will be made after May 31, 2018. Cancellation must be received
in writing.
Please see hearingloss.org/content/convention for news
and updates as well as the Code of Conduct policy. Cancellation date will be determined by USPS postmark or email receipt date.