Hearing Healthcare Alliance of Ohio

2012 SPRING SEMINAR REGISTRATION
Saturday, March 3, 2012
Embassy Suites
Dublin, OH

	Alliance Members	Non-Members
Early Registration - Postmarked by Feb. 10, 2012	$125.00	$160.00
Registration - Postmarked after Feb. 10, 2012	$135.00	$175.00
Registration at the Door	$145.00	$190.00

AGENDA - TO BE ANNOUNCED

For additional seminar information, contact Catie Washburn at (937) 433-8080.
CLICK HERE for printable registration form Mail this registration form and payment to: Joe Rosengarten, Treasurer, Hearing Healthcare Alliance of Ohio, 6601 Taywood Drive, Englewood, OH 45322-3761 *Please Print Legibly!*
Name:	________________________________________
Non Member Name:	________________________________________
Address:	________________________________________
City/State/Zipcode:	________________________________________
Phone:	________________________________________
Amount Enclosed:	$_______________________________________
Check Number*:	________________________________________
* There is a $30.00 returned check charge