Annual Membership

CHIP membership is extended to people affected by hearing loss, hearing health professionals, anyone who supports our mission. Please note, the membership fee is due annually. Members have the right to vote at our Annual General Meeting (AGM), receive a copy of the Spring and Fall issues of the Hear Hear Magazine (formerly the Communicaider), and are eligible to participate in our programs and services.

PLEASE FILL OUT ALL OF THE QUESTIONS BELOW.

After you submit your membership form you will be directed to a new page to pay your membership fee, donations are also warmly encouraged!

First Name

Last Name

Mobile phone

Send me email updates

Send me text message updates

Phone

Address (Street, City, State, Postal code)

Country

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Emergency Contact

Emergency Phone

Do you have any medical conditions?

What is your date of birth? Please use MM/DD/YYYY format.

How long have you been a member of CHIP?

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How did you hear about CHIP?

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Do you give CHIP permission to use your photo? See below for more details.

I hereby authorize Communicaid for Hearing-Impaired Persons, also referred to as “CHIP”, to publish photographs taken of me, my name and likeness, for use in the CHIP’s print, online and video-based marketing materials and other organization publications. I hereby release and hold harmless CHIP from any reasonable expectation of privacy or confidentiality associated with the images specified above.

I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with publication of these photographs.

I hereby release CHIP, its contractors, its employees, and representatives involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.