Hearing Loss May/June 2010 - 11

CONVENTION REGISTRATION FORM

Hearing Loss Association of America® Convention 2010
Hilton Milwaukee City Center and Midwest Airlines Center June 17–20 • Milwaukee, Wisconsin
Please complete and return registration form by May 26, 2010.

__________________________________________________________________________________________________		 Primary	Registrant	(name	as	it	will	appear	on	badge)	 	 	 __________________________________________________________________________________________________	 Second	Registrant	 	 	 __________________________________________________________________________________________________	 Company	/	Organization __________________________________________________________________________________________________ Address ____________________________________________________________________________	 ______________________	 _ City	 	 	 ___________________________________________________________________________	 Daytime	Phone	

___________________________________________________________ HLAA	Member	ID# ___________________________________________________________ HLAA	Member	ID# Providing your e-mail address helps us in our effort to “Go Green” and allows us to e-mail convention updates as they occur.

_____________________________	 State	 	

__________________________ Zip

__________________________________________________________________________________ E-mail	

For quick and secure registration, visit us online: www.hearingloss.org

o What Children with Cochlear Implants Need at School
	 	 Half	Day	Workshop	for	Parents	and	School	Professionals Registration	also	includes: •	 Unlimited	Entry	to	the	Exhibit	Hall	During	Expo	Hours	on	Thursday,	June	17 •	 Opening	Session 	

By 5.26.10

Onsite

o $	

50	

o N/A

VALUE PACKAGES

o Full Activity Package (Best Value) 																														 	
	

By 5.26.10 Member	 Member	Couple	 First-Timer 	 First-Timer	Couple 	

Onsite N/A N/A N/A N/A

	 					 				 Hearing	Loss	Association	Convention	Full	Activity	Package	includes: •	 Unlimited	Entry	to	the	Exhibit	Hall	During	Expo	&	Session	Hours •	 All	Workshops,	Demonstrations	&	Featured	Speakers •	 Research	Symposium •	 Opening	Session	&	Exhibit	Grand	Hall	Opening •	 Get	Acquainted	Party	(GAP) •	 Awards	Breakfast •	 Exhibit	Hall	Socials	on	Friday	and	Saturday •	 Workshop—What Children with Cochlear Implants Need at School •	 Oktoberfest in June Ticket(s) (Saturday Evening Banquet) 	 Special	Dietary	Requests									o Vegetarian					 Kosher				o Diabetic o

*

o $	 o $	 o $	 * o $	

319	 558	 289	 528	

Must be an HLAA member who has never *attended an HLAA convention in the past to qualify for First-Timer discount.

More packages on reverse side.
Hearing Loss May/June 2010

Table of Contents for the Digital Edition of Hearing Loss May/June 2010
