Full Name

Address

City

State

Zip

Phone

Email

School District

Children (Deaf/HH & Siblings, ages, communication method)

1)

2)

3)

4)

5)

6)

Parent Scholarship Requested

Annual Membership Fee - pick one

$25 - Student/Parent/Deaf Adult

$40 - Professional

$50 - Business

Activities and Information
To help us better serve you, please check the following activities/information that you would be interested in:

	Educational Seminars
	Methodology Choices
	Networking with other Parents in Your Area
	Advocacy Training
	Lobbying/Legislation
	Deaf Culture
	Hard of Hearing

	Transition
	Early intervention to Pre-School
	Pre-School to Kindergarten
	Elementary School to Middle School/Jr. High
	Middle School/Jr. High to High School
	High School to Secondary School/Work Force

Would you like to voluneteer? Let us know what areas are a good fit for you:

	Serve on a Committee
	Gather Information/Resources/Notices of upcoming events in your area
	Write Articles for the Newsletter
	Other

Please type AZHV in the box below