Check one or more boxes that apply to you.

HLA of Snohomish County meets monthly Sept. through June (with a picnic in August). The chapter sends out the "Hearing & Beyond" newsletter on the same schedule. We need your support to keep the HLA of Snohomish County functioning. You can help us continue to support and educate people who has a hearing loss, with an annual contribution from you of:

5 New or  5 Renewal  $13.00 for one person (Chapter Support Fee)

5 $15.00 for a family (Chapter Support Fee)

You may also send in your Hearing Loss Association of America membership through us. Check the box below

5 $30.00 to become a member of HLAA. This includes the Hearing Loss Journal plus other benefits.
 

 Name:__________________________________________________________________

Address:________________________________________________________________

City:___________________________State_______________Zip Code_____________

Phone Number __________________________  TTY / VOICE (Please circle one)

E-mail Address _____________________________________________________

How did you learn about HLAA (Hearing Loss Association of America)?

___________________________________________________________________

Please make the check to HLA-SnohomishCounty and mail it along with this form to:

David Pearson, Treasurer

HLA of Snohomish County
PMB # 648

13300 Bothell-Everett Hwy

Mill Creek, WA  98012
 

Thank you for your Contribution