Membership Application – HAC Task Force

Members
Membership Application
Contact

Members Membership Application Contact

Membership Application

November 15, 2019

Organization *

Primary Contact *

First

Last

Title

Phone *

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is the primary contact also the billing contact? *

Yes
No

Billing Contact *

First

Last

Title

Phone *

Email *

Please select the option below that best describes the entity applying to join the HAC Task Force. *

Wireless OEM
Wireless Service Provider - Tier 1
Wireless Service Provider - Tier 2
Wireless Service Provider - Tier 3
Hearing Aid Manufacturers and Representative Associations
Research and Academic Institutions
Other

If you answered "Other" to the previous question, please elaborate.

HAC Task Force Operating Procedures *

Applicant agrees that, upon approval of participation in the HAC Task Force, it will abide by the Task Force Operating Procedures.

Phone

For questions regarding HAC participation or fees, please contact Rich Moran, ATIS Director of Membership.

© 2019 ATIS