2008 REGISTRATION & FEES
Mail: Acoustic Associates, 1278 W. Northwest Hwy – Suite 904, Palatine, IL 60067
Phone: 847-359-1068 Fax to: 847-359-1207 Email to: seminars@AcousticAssociates.com
Fed. I.D. # 36-3422514 www.AcousticAssociates.com
Name __________________________________________________________________
Degree ________________________ Position _________________________________
Company _______________________________________________________________
Address ________________________________________________________________
City, State, Zip ___________________________________________________________
Phone ______________________________ Fax ______________________________
Email __________________________________________________________________
How did you hear about us? __ Supervisor __ Brochure
__ Coworker __ Print Ad __ Previous Student __Post Card
__ CAOHC Website __ www.AcousticAssociates.com
Please register me for the following seminar (circle one):
CAOHC Training Course 3-day $945
Feb 6-8 Apr 16-18 June 25-27
Aug 27-29 Oct 15-17 Dec 10-12
CAOHC Advanced Refresher Seminar* 1-day $395
Feb 5 June 24 Oct 14
CAOHC Basic Refresher Seminar* 1½-day $475
April 16-17 Aug 27-28 Dec 10-11
Hearing Conservation Strategies (HCS)+ 1½-day $475
Feb 6-7 Apr 16-17 June 25-26
Aug 27-28 Oct 15-16 Dec 10-11
Audiometric Testing (AT)+ 1½-day $475
Feb 7-8 Apr 17-18 June 26-27
Aug 28-29 Oct 16-17 Dec 11-12
Noise Assessment (NA) ½-day: prerequisite HCS or CAOHC cert. $195
April 17 Aug 28 Dec 11
CAOHC Certification
(free
with payment 30 days prior)
$ 70
CAOHC Re-Certification (free with payment 30 days prior) $ 60
-Current CAOHC Cert. No. ___________ -CAOHC Exp. Date ____________
Products
- CAOHC Hearing Conservation Manual $ 70
- ENT Pocket Light Otoscope $ 45
- “Say What” Audio Demonstration CD $ 25
- ER-20 High Fidelity Earplugs $ 15
Note: For mail-orders, add 15% Shipping and $4.00 Handling $ ________
TOTAL: __________
METHOD OF PAYMENT
__ Check (payable to Acoustic Associates, Ltd.)
__ Purchase Order: No. ____________________________ (add $25 admin. fee)
__ Credit Card: VISA ___ MC ___ DISCOVER ___ AMEX ___
Card Number: ____________________________________________ Exp. Date: ____________
Signature: ___________________________________________________