Member Application

Home Information

* First

* Last

* Address

* City

* State

* Zip

* Home No.

Cell No.

* Preferred Email

Alternate Email

Work Information

Work Name

Address

City

State

Zip

Work No.

Fax No.

* Circle region you live/work in

* AAA Member

* GA Audiology Lic.

Enrolled in Au.D. Program & Where?

* Populations served

* Setting

* Specialty

Were you recruited by a GAA Member? If so, who?

Tax Disclaimer: The Georgia Academy of Audiology is a not-for-profit assicaiton, with 501 (c)(6) status with EIN or tax ID number 01-0644342. This status allows members to partially deduct memberships as a business expense but not as a charitable contribution. The GAA estimates that 26% of dues are not deductible in accordance with the Internal Revenue Service.

*This information should be on your Voter Registration card. If you do not have a Voter Registration card, please call your county Board of Registrars office. The telephone number should be listed under the county government listings in your local telephone book. You may also go online to www.georgia.gov. Click on “Government”, then “State Government”, then “Legislature”, then “Find Your Poling place and Elected Officials.” Enter your information and your voter’s registration card will appear online through the Secretary of State’s website.

Are you interested in supporting the protection of our audiology profession? Our academy's Political Action Committee (PAC) is the MOST important way we fund our right to practice audiology in our state.

Yes
No

Are you interested in helping with our GAA convention or with one of our other important committees?

Yes
No

By clicking "Submit" I agree to abide by the by-laws of the Georgia Academy of Audiology

Members Log In
Georgia Academy of Audiology ID:

Password:

	Forgot Username/Password?