Pennsylvania Academy of Audiology: Dedicated to PA Audiologists.

Thank you to our Recent Donors for contributing to our PAC FUND!!
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  • Donate to Sponsor a Student

If you are donating to sponsor a student for the 2017 convention, please write "STUDENT CONFERENCE SCHOLARSHIP" in the comment section! 

The amount to sponsor a student is $75.  Sponsorships will be granted for as long as funds and student requests are available.  If you are unable to donate the entire $75, any amount will be added to other donations in an effort to support as many students as possible.  We appreciate any and all donations.

Thank you!

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Donation

* Mandatory fields
*e-Mail
Please use your permanent e-mail (do not enter your university email if you are a student).
*First name
*Last name
Suffix/Designation
*Title
Please enter any credentials after last name
Middle Initial
*Organization
*Best Number to reach you
Please include extension.
*Main Office Name
*Main Office Address Line 1
*Main Office Address Line 2
*Main Office Address City
*Main Office Address State
*Main Office Address Zip Code
*Main Office Phone
*Main Office Fax
Second Office Name
Second Office Address 1
Second Office Address 2
Second Office Address City
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Second Office Address Zip Code
Second Office Phone Number
*Home Address 1
*Home Address 2
*Home City
*Home State
*Home Zip Code
Professional afilliations
Clear selection
Please check the organizations in which you are a member. If you selected other please specify below.
Scope of Practice
What ages of patients do you see?
Services Provided
Practice an LLC?
*My Volunteer options
PAA is our professional organization. Your help would be truly appreciate it.
Setting
The setting of this office can best be described as a
What is your position in the office?
Dispenser?
Licensed in PA?
*Home Phone
(not visible to the public).
Website Address
2019 Vendor Prospect
*Amount ($USD)
Comment

Remember to write "STUDENT CONFERENCE SCHOLARSHIP" in the comment section!  Otherwise, the donation will be added to PAA's general fund.

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