OHADA Membership & Conference

To print and fill out a registration form and mail it in with a check please click here for a PDF version.

Please mail your printed form to: Central States Conference on Hearing, P.O. Box 451, Elk City Oklahoma 73648
Or fax it to: 405-896-9364 Attention: Wayne Morris CSCH

Personal Information
*Required fields - errors will occur if these fields are not filled out properly.
Name*
First Last
Last four digits of your Social Security number.*
Please enter a number from 0 to 9999.
Just the last four please, required for CEU tracking.
Company Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*

Please enter your valid email address so that we can send you confirmation of your registration.
Website
Office Phone*
Cell Phone
Please check all that apply:
- Hearing Instrument Specialist
- Audiologist
- Student
- Other
If Hearing Instrument Specialist please enter your license number.
If other please explain:
OHADA Membership/Conference Options - Please select one of the following.*
- Membership Only - $100
- Membership + Live Conference - $300
- Membership + Virtual Conference - $250
- Student Membership + Live Conference - $100
- Student Membership + Virtual Conference - $50
REFUNDS: Full refund of fee will be made if cancellation notice is received at least two weeks prior to the opening date of the convention. (Must be postmarked two weeks prior or before). A 50% refund will be made if cancellation is received by 5:00 p.m., two weeks before the date the conference begins. NO REFUNDS WILL BE MADE AFTER THAT DATE.
Additional Memberships/Registrations
2nd Membership/Conference Registration:*
- Yes
- No
Would you like to add a second person to your order for membership and/or conference registration?
2nd Membership/Conference Registration Information
2nd Membership/Conference Registration*
First Last
Email for 2nd Member/Conference Registration
Company Name for 2nd Member/Conference Registration
Phone for 2nd Member/Conference Registration
Address for 2nd Person*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Last four digits of the 2nd person's Social Security number.*
Please enter a number from 0000 to 9999.
Just the last four please, required for CEU tracking.
Please check all that apply for second person:
- Hearing Instrument Specialist
- Audiologist
- Student
- Other
If second person is a Hearing Instrument Specialist please enter their license number.
If other please explain:
OHADA Membership/Conference Options - 2nd Person - Please select one of the following.
- Membership Only - $100
- Membership + Live Conference - $300
- Membership + Virtual Conference - $250
- Student Membership + Live Conference - $100
- Student Membership + Virtual Conference - $50
3rd Membership/Conference Registration:*
- Yes
- No
Would you like to add a third person to your order for membership and/or conference registration?
3rd Membership/Conference Registration Information
3rd Membership/Conference Registration*
First Last
Email for 3rd Member/Conference Registration
Company Name for 3rd Member/Conference Registration
Phone for 3rd Member/Conference Registration
Address for 3rd Membership/Conference Registration*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Last four digits of the 3rd person's Social Security number.*
Please enter a number from 0000 to 9999.
Just the last four please, required for CEU tracking.
Please check all that apply for third person:
- Hearing Instrument Specialist
- Audiologist
- Student
- Other
If third person is a Hearing Instrument Specialist please enter their license number.
If other please explain:
OHADA Membership/Conference Options - 3rd Person - Please select one of the following.
- Membership Only - $100
- Membership + Live Conference - $300
- Membership + Virtual Conference - $250
- Student Membership + Live Conference - $100
- Student Membership + Virtual Conference - $50
4th Membership/Conference Registration:*
- Yes
- No
Would you like to add a forth person to your order for membership and/or conference registration?
4th Membership/Conference Registration Information
4th Membership/Conference Registration*
First Last
Email for 4th Member/Conference Registration
Company Name for 4th Member/Conference Registration
Phone for 4th Member/Conference Registration
Address for 4th Membership/Conference Registration*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Last four digits of the 4th person's Social Security number.*
Please enter a number from 0000 to 9999.
Just the last four please, required for CEU tracking.
Please check all that apply for 4th person:
- Hearing Instrument Specialist
- Audiologist
- Student
- Other
If 4th person is a Hearing Instrument Specialist please enter their license number.
If other please explain:
OHADA Membership/Conference Options - 4th Person - Please select one of the following.
- Membership Only - $100
- Membership + Live Conference - $300
- Membership + Virtual Conference - $250
- Student Membership + Live Conference - $100
- Student Membership + Virtual Conference - $50
Non Registration Meal Packages
Non-registered guests that require meals during the conference.*
- Yes - I will need to purchase additional meals.
- No - No additional meals are necessary.
Spouses and others are welcome to attend. Conference meals are included with registration fees, non-registered attendee's meals may be purchased here. Please indicate the number of additional meals you would like to purchase at this time, so we know how many to prepare for. Thank you.
Single day meals package - $50
Price: $50.00
Live Conference Options include meals for (1) attendee; if additional meals are required, please let us know how many.
Two day meals package - $100
Price: $100.00
Live Conference Options include meals for (1) attendee; if additional meals are required, please let us know how many.
Total
$0.00

To print and fill out a registration form and mail it in with a check please click here for a PDF version.

Please mail your printed form to: Central States Conference on Hearing, P.O. Box 451, Elk City Oklahoma 73648
Or fax it to: 405-896-9364 Attention: Wayne Morris CSCH

Promoting better hearing to the Oklahoma Community!

OHADA Membership & Conference

Personal Information

Additional Memberships/Registrations

2nd Membership/Conference Registration Information

3rd Membership/Conference Registration Information

4th Membership/Conference Registration Information

Non Registration Meal Packages

Current Officers

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