ARA Membership Renewal Form

First Name:
Last name:
Year conferred:
Preferred Contact Address:
Street Address:
Zip Code:
Email (Required)
Primary Specialty: Audiology
  Speech-Language Pathology
Deaf/Hearing Impaired Education
Membership Category: Regular ($55.00/year)
  Associate ($40.00/year)
  Student ($20.00/year)
  Life ($0)
If you wish to pay online, continue to the submit button and you will be directed to a page with a
PayPal payment button directing you to ARA's secure payment site.  Please enter the membership
category you have chosen above when making your PayPal payment.

Please enter the name on your credit card:

If you would like to pay by check, print out this page and send it along with a check made out to the
Academy of Rehabilitative Audiology to:

Peg Palmiere, Association Coordinator
Academy of Rehabilitative Audiology
PO Box 2323
Albany, NY 12220-0323



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