FLAA Hearing Technology Day Talking Teams

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for joining Florida Academy of Audiology in Tallahassee on March 6 to spread awareness in the capitol about hearing health and hearing aid access legislation. Please complete this form to help us customize visit lists and prepare for your visit.

Name *

Please check all that apply *

Audiologist

Parent of a child with hearing loss

Other relative of a child with hearing loss

Adult with pediatric onset hearing loss

Adult with late onset hearing loss

Audiology Student

Other Student

Other Professional in the Field

Required

Home Address *

Secondary Address (For students or others who are from another part of Florida, this will help us connect with the home districts of more legislators.)

Do you have any connections with current legislators that would be helpful for us to know?

Are you willing to participate in a training call to lead a talking team on the 6th? *

Yes, I would love to help.

Not this time.

Best contact method and info (text - include phone number; email - include email address) *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms