Embed Size (px)
Citation preview
Volume 15 | Number 1
FLORIDA ACADEMY of AUDIOLOGY
AudiologyAdvocate
President Ali Danesh, Ph.D. Labyrinth Audiology & Florida Atlantic University (561) 297-2071 [email protected]
President Elect Holle Aungst, Au.D. Arnold Palmer Hospital (321) 841-1957 [email protected]
Vice President of Education James W. Hall, III, Ph.D. Nova Southeastern University (352) 275-6335 [email protected]
Vice President of Professional Affairs Cindy Simon, Au.D. South Miami Audiology Consultants (305) 663-0505 [email protected]
Vice President of Membership Dana Ulmer, Au.D. University of Florida (352) 273-5315 [email protected]
Vice President of Communications Kelly Hansen, Au.D. Trinity Hearing & Balance Center (727) 372-1130 [email protected]
Treasurer Sergio Guerreiro, Au.D. University of Miami (305) 243-1950 [email protected]
Secretary Devon Weist, Au.D. University of Florida (727) 341-0529 [email protected]
Past President Joseph Duran, Au.D. New Generation Hearing Centers (305) 551-7222 [email protected]
Executive Director Rachel M. Brooke Maxim Management (561) 414-0675 [email protected]
FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE VOLUME 15 | NUMBER 1 TABLE OF CONTENTS
cont
ents
EXECUTIVE BOARD
President’s Message . . . . . . . . . . . . . . . . . . . . . . . . 3
FTRI Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
FLAA Student Update . . . . . . . . . . . . . . . . . . . . . . . 4
Professional Affairs Report . . . . . . . . . . . . . . . . . . 6
News Flash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Education Update . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Student Liasion Update . . . . . . . . . . . . . . . . . . . . 9
Past President Article . . . . . . . . . . . . . . . . . . . . . . . 10
FLAA’s Regional CEU Blitz . . . . . . . . . . . . . . . . . 11
Call for Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Member Renewal Form . . . . . . . . . . . . . . . . . . . . 14
By ALI DANESH, Ph.D., 2013 President | [email protected]
Welcome Florida Academy Members to 2013!
I’m grateful for the opportunity to serve you as President in the coming year and very excited to hit the ground running.
To best serve you, we are starting off the year with some CEU programming to help you accumulate hours before your license needs to be renewed. Check out the details of our four upcoming programs during our February CEU Regional Blitz later in this issue. I hope that many of you will take advantage of this great FREE opportunity and get your CEUs early.
I’m sure many of you are anxiously awaiting our 2013 Annual Convention as well. We are very excited to host the 2013 Annual Convention at the Hilton Orlando Bonnet Creek in Orlando, Florida. This hotel is conveniently situated within Walt Disney World and provides you with a great opportunity to bring the family along and enjoy those last few days of summer vacation. I know that Dr. Jay Hall is already busy at work securing the very best speakers in the country for our program, but if you are interested in speaking as well, please complete the Call for Papers form in this issue and submit it to him for consideration.
President’s Message
“I look forward to a very successful year ahead.”
1-800-221-0188 l www.widexpro.com
Widex MENU • Florida Academy of Audiology • 3.5 x 4.5 • Second Issue • freshbrick 631.285.7825
With MENU hearing aids, you, along with your patients, can select the features needed to suit their hearing loss, lifestyle and budget.
EVERYTHING IS ON
THE MENU
WX_Menu_FAA_QuarterPage_0612.indd 1 5/9/12 12:17 PM
For more information call Oticon at 1.800.526.3921 or visit us online at www.oticonusa.com.
Intigai Intiga RITE
A hearing solution that is discreet or even invisible
What are first-time users looking for?
FTRI Update
4 | FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE
FTRI has exciting news to share with FLAA members. Two new phones have been added to our distribution inventory to meet specific hearing and speech needs of Florida residents. The new equipment includes:
ClearSounds CSC500The CSC500 is ideal for someone with mild to moderate hearing loss. This phone is line powered and does not require electricity. Other features include:
• Hearingaidcompatible
• Amplifiesincomingvolumeupto 40 dB with amplify button
• Boostoverridebuttonallows amplification to always be on
•Adjustablebright,visualringer with volume up to 85 dB
•RingervolumecontrolOff/Lo/Hi(tone)
•Bigbutton,easy-to-readkeypad
• Easyone-touchdialing:8pictureand3one-touchmemory dial buttons
• 2.5mmheadsetjack
• Lastnumberredial,callwaiting,mutebutton,andflash button
• Fullduplexspeakerphoneinbase
Serene HD40SThe HD40S is ideal for individuals that need more outgoing(speech)amplification.Featuresinclude:
• Hearingaidcompatible
• HDS(High-DefinitionSound)toassistinmakingthe voice sharp, clear and easily audible
• Amplifiesoutgoingspeechupto40dB
• Canbeeasilysettoamplifyincomingsound up to 18 dB
• LatestDSP(DigitalSoundProcessing)technologyeliminates virtually all distortion, echo effects and unwanted static commonly found in other ordinary amplified phones
• 9easy-to-usephoto-memory buttons for
one-touchdialing
• Two(frontandside)visualringflashers
• 95+dBsuper-loudringerwithadjustableringvolume and tone controls
• Batteryback-upforpoweroutages(batteriesnotincluded)
Customer Care: “How Can I Help You?”In June, FTRI launched a major expansion of the Customer Care program. Email surveys are now sent
to all new clients who provide an email address. The first survey queries customer service and
training when the phone was received. The second survey is sent 30 days later and asks
client’s satisfaction with phone volume and clarity. The average respondent’s age is 75; the oldestrespondentto-date:100years.
The surveys allow FTRI staff to quickly resolve any problems clients may encounter and possibly
eliminate the need to revisit their local distribution center. Common issues easily resolved include:
• MakesurethephoneisontheToneandnotPulsesetting
• Fullychargeanewcordlessphone(12hours)
• Useafilter(providedbyFTRI)toreducestatic,especiallyondigitallines(phoneservicethrough acableprovider)
• MakesuretheACpowerispluggedin(forphoneswithACpower.)
FTRI clients with questions are encouraged to call the Customer Care line. The results so far are significant: sixty-fivepercentofallcallsareresolvedthroughCustomerCaretrouble-shooting.
Please encourage your patients to contact FTRI Customer Care with any questions about their FTRI phone.Thenumbertocallis888-554-1151,orbyemailat [email protected]. FTRI appreciates your strong support of the specialized phone program. If you need applications or have questions about the FTRI program, contact [email protected].
THE RESULTS ARE IN!DANA L. ULMER, Au.D., CCC-A Vice President of Membership
Thank you to everyone who participated in the membership survey at this year’s Annual Convention. The results of the survey show that 44% of participating members feel the highest priority of their membership is FLAA’s lobbying efforts to protect our profession with the annual convention coming in second at 33%. We are also working hard to integrate all of your comments into our membership strategy. Couldn’t join us for convention? Be on the lookout for our membership survey via email. Your comments and suggestions are always welcome at [email protected].
FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE | 5
The future of our profession is in the hands of our student audiologists! I would like to recognize some very special students! Congratulations on your achievements!
I would like to thank the 2012 Student Liaison committee: Rud Nast and Elizabeth Aitkin from the University of Florida, Shelly West and Alex Klein from the University of South Florida, and Annie Rodriquez from Nova Southeastern University. These students worked hard all year attending committee meetings, contributing to The Advocate, and promoting The Florida Academy of Audiology to their peers.
The FLAA convention was an exciting time for our audiology students! The Outstanding Student Recognition Awards were presented to Erica Kuelz from University of South Florida, Victoria Ledon from University of Florida, and Annie Rodriguez from Nova Southeastern University. Shawna Dell from University
ofFloridaandMakenzieKlinefromUniversityofSouthFlorida were presented the Student Research Award. Congratulations to you all! Congratulations also to the students who were recognized at the White Coat Pinning Ceremony!
I want to also thank the members of FLAA for allowing metoserveontheboardforthepastfiveyears.Myterm ended at the end of 2012. It has been a fun and worthwhile experience! I would like to encourage other members to consider running for an office or serving on a committee. We need your participation! I will you all a Happy and Healthy New Year!
By SHARON ROPHIE, Au.D.
FLAA Student Update
“The future of our profession is in the hands of our student
audiologists!”
The Cochlear™ Baha® System may be able to help your adult patients with single-sided deafness or mixed & conductive hearing loss.
www.CochlearAmericas.com
Open the door to
a world of sound
BUN123 ISS1 AUG12
System Candidacy GuidelinesSingle Sided Deafness Poor Ear • Profound SNHL
Good Ear: • PTA AC Threshold
≤ 20 dB @ 500Hz, 1kHz, 2kHz and 3kHz
Mixed and conductive • Pure tone average
bone conduction threshold better than or equal to 65 dBHL (Measured at 500Hz, 1kHz, 2kHz and 3kHz )
Hea
ring
thr
esho
ld (
dBH
L)
Frequency [Hz] Frequency [Hz]
500 1000 2000 4000250
Hea
ring
thr
esho
ld (
dBH
L)
500 1000 2000 4000 6000 8000125 250
0
10
20
30
40
50
60
70
80
90
100
110
120
0
10
20
30
40
50
60
70
80
90
100
110
120
Moderate
Severe
Profound
BP100
BP110
Cordelle II
Baha 3 Sound Processor(BP100)
Baha 3 Power Sound Processor(BP110)
Baha Cordelle IISound Processor
Frequency [Hz]
©2012 Cochlear Limited. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited.
6 | FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE
Hi all.
What a great meeting we had in Saint Augustine. And what a great job those attending the business breakfast did in stepping up and donating for our lobbyist. We raised over $2,500. It was a great effort, but unfortunately was still not enough to continue keeping our lobbyist on a long term basis.
Please look at our profession and our needs. There is no offering too small or too large to help us keep our lobbyist. This will be an important year. Sunset could come up and we need to be prepared. We will need to work both offensively as well as defensively on the UHC issue and direct access. Remember, we have many newlyelectedofficialsandnewlyre-electedofficials.
I would like to remind everyone of another upcoming issue for 2013 for all audiologists. We have all been receiving emails from AAA, ADA, and ASHA but there are often so many emails that many get deleted before reading. The Physician Quality Reporting System (PQRS)changescouldhaveimpactonMedicarePartBreimbursements beginning in 2015. There are new G codes to add to our reporting. We have to report at least
one PQRS measure in 2013 to avoid a deduction of 1.5% per claim from 2015 payments. There is a step by step resource guide available regarding this reporting and this link can be found at AAA, ADA, or ASHA websites. Protect yourselves and become familiar with this. The MedicarePhysicianFeeSchedulefinalrulewillbeoutaround the first of November so watch your emails for updated information from your national organizations.
By CINDY SIMON, Au.D., Vice President, Professional Affairs | [email protected]
Professional Affairs Report
A personal conversation with Audigy Group’s Membership Development Team can give you a better understanding of how we can help you achieve your personal, professional, and financial goals.
Contact us at 877.702.2426 or visit www.audigypro.com to learn more.
Come Grow with Audigy Group
Partner with Audigy Group to take your practice to the next level. Each of Audigy Group’s Member/Owners have realized significant improvement in every area of their practice. By harnessing the power of industry-leading services in finance, human resources, professional development, operations, and marketing, they are meeting and—in many cases—exceeding their personal, professional, and financial goals.
BoB Manning
Past President, ADA
Mary CaCCavo
Past President, ADA
ErIC HagBERg
President, ADA Education Chair, ADA
anGEla LoavEnBRuCk
Past President, AAA
JaMEs M. MCDonaLD
Past President, ADA
MarlEnE BEvan
Past President, ADA
rICHarD ganS
Past President, AAA
ErIC HECkER
Board and Committee Member, AAA Board and Committee Member, ADA
The Audigy Group Presence Over 240 AG Members, with 600+ locations across North America,
representing the most elite private practitioners in the country.
Visit us at
Booth 22 Our dedicated
Membership Development Specialists look forward to
speaking with you.
COMMUNICATIONS CORNER
Do You Have News For The Advocate?E-mailVP,Communications, Kelly Hansen, Au.D. at [email protected] to submit your ideas or articles.
What a great meeting we had in Saint Augustine. And what a great job those
attending the business breakfast did in stepping up and donating for our lobbyist.
FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE | 7
A newly styled 312 RIC and 312 mini BTE, 3 Series comes with our industry-leading performance features, offers all the unique benefits of our IRIS technology - including completely wireless programming and media streaming - and introduces several patient-driven extras.
Visit StarkeyPro.com/3Series for a virtual demo. Or contact your Starkey Representative to order today. 800.328.8602
Be sure to visit us at booth #19!
PATIENT DRIVEN ON THE OUTSIDE,PERFORMANCE TESTED INSIDE
TJAD0160-00-EE-ST_Final.indd 1 8/6/12 9:32 AM
Wow! For those who have been following the ADA listserv, the gauntlet was thrown down by Dr. Greg Frasier for each member to donate $1000 to support a lobbyist and to raise $100k. That was September 28th.ByOctober5th,theyhadraised$120.AsofOctober22nd,theyraised$172,375.00.THEMOMENTUMIS ON!!! AUDIOLOGY CARES!!!! AUDIOLOGY HAS SPOKEN.
FLAA now throws down the gauntlet in Florida. BE PART OF THE SOLUTION. Whether you give to ADA, AAA, or to FLAA, give. We challenge YOU to think of FLAA and give $100, more if you can, less if you can’t.
We have a great lobbyist concerned with Florida issues. His primary focus for us is Direct Access. Help up help you by keeping our lobbyist.
PLEASE GIVE, Keep the momentum going. We thank you in advance.
Colleagues:
It has been my greatest pleasure to be your VP of education for the past 4 years. This year we were blessed to have Rachel Brooke back in our camp as the executive director. Welcome back Rachel!. St. Augustine 2012 was well received by our members. Overall the conference feedback forms could not have been more positive despite being in the north part of the state. We took a chance to do something new and according to your feedback it paid off.
Thank you for all your support and encouragment during the past 4 years. I have no doubt that the next 2 years will be even greater with Jay Hall at the helm.
See many of you at the regional seminar.
Regards,
Sergio
By SERGIO GUERREIRO, Au.D., Outgoing Vice President, Education
Education Update
www.usa.siemens.com/eclipse
Life sounds brilliant.
She can relax. We made it comfortable.Eclipse™ XCEL. Information for Hearing Care Professionals.
“Thank you for all your support and encouragment during the past 4 years. I have no doubt that the next 2 years will be even
greater with Jay Hall at the helm.”
FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE | 9
The 16th annual Florida Academy of Audiology Convention once again played host to students from around the state and honored them with a commemorative lapel pin. On Friday, August 25th, family and friends of second year students from the University of Florida and the University of South Florida gathered together to celebrate the students’ efforts toward a career in audiology. Each year the Florida Academy of Audiology presents a gift to conference attendees completing their first year of the Au.D. program. Students recited The Audiology Oath before being “pinned” by the faculty representative from their University. This year the pin was specific to the Au.D. class of 2015, and represents the Florida Academy of Audiology’s commitment to the future of our profession.
Bettina Tucker, Au.D., accompanied the six students from the University of South Florida. The 15 students from the University of Florida were joined by Deb Shimon, Au.D. Distinguished speakers included: Debrah Carlson, Ph.D., president, American Academy of Audiology; Sergio Guerriero, Au.D., vice president of education, Florida Academy of Audiology; and Adrian Eshraghi,MD,AssociateprofessorofOtolaryngology,UniversityofMiamiSchoolofMedicine.
Congratulations to these students taking the next step toward their future careers.
Doctor of Audiology Class of 2015 White Coat Pinning Ceremony By LIZ AITKIN, RUD NAST and SHELLEY WEST
Student Liasion Update
USF attendees(fromLtoR):NadaHanna,DanielleO’Neil, ShelleyWest,BrookeWorthington,MollyEngland,KatieAustin and Bettina Tucker
UF attendees (backrowLtoR):AshleyMarcus,JoshGilbert,Samantha Vrooman, Cait Simmons, Peggy Warner, Liz Aitken, KatelynDiPietro,MelaniqueFairman,TrinaFazio,KristenDavis,andEvansPembra.(FrontrowLtoR):KelseyChrist,LindsayMay,and Becky Dame. Not Pictured: Angela Vandoli
Damion Campbell , Alexis Cohan, Faria Elbabour, Julia Fahrney, RyanMalkiewicz,VivianaMartinez,TegestNuguse,LisaPerez,SherryRauh,WilliamRoach,Vjolka(Lola)Zaka,MichelleZiegler
Nova Southeastern class of 2015
Congratulations to these students taking the next step
toward their future careers.
FloridaAcademyMembers,
It was a privilege serving as the FLAA President in 2012.
There were many positives to 2012 including the fact that we avoided any major legislative issues affecting the profession. Aside from that, we successfully hosted, yet another, Annual Convention despite storm threats and even broughtinseveralnewFloridaAcademyMembersandnewConferenceAttendeesasaresultofvisitinganewpartof the state. The Board certainly learned a lot from doing this and we will continue to explore alternative venues to increase membership in the future. As I have said in the past, there is great strength in numbers!
I know you are in great hands with Dr. Ali Danesh at the helm for 2013 and I look forward to continuing my service as aFLAABoardMemberthiscomingyear.Here’stoagreat2013!
By JOSEPH DURAN, Au.D., Past President | [email protected]
Past President Update
“As I have said in the past, there is great strength in numbers!”
FLAA NORTHWEST REGIONAL PROGRAM Sponsored by Starkey
Directing Patients Toward Better Hearing
Date: Friday, February 1, 2013 Time: 8:00 am – 12:00 pm Location: Four Points by Sheraton, Jacksonville, FL
Advancements in hearing aid technology require education to adequately prepare for fitting hearing aids to patients with hearing loss. Although hearing aids and software have become increasingly complex, patient reports have remained essentially unchanged. Therefore, professionals must be aware of the product differentiation and available adjustment parameters to resolve these reports.
Patients also tend to be more active in more environments and are interested in high tech solutions fortheirphoneandaudioneeds.Matchingthepatient’sneeds to the most appropriate technology and wireless accessories is a critical component to a successful hearing aid fitting and satisfied hearing aid user. Effective product demonstration leads to this successful outcome.
In addition, today’s patients are coming to our offices with information about products and are more involved in their journey to better hearing. Practitioners must be able to use available software and mobile applications
such as SoundPoint to include the patient in the fitting process to optimize the hearing aid fitting experience.
This course will discuss how to identify differences in product technology levels and match these differences to patient needs, use available counseling and interactive software and mobile applications to include the patient in the hearing aid fitting and demonstrate the benefit of wireless accessories to enhance the performance of the hearing aids in a variety of environments.
FLAA SOUTHEAST REGIONAL PROGRAM Sponsored by Acoustical
Moving Your Fittings Forward Through Verification
Date: Friday, February 8, 2013 Time: 8:00 am – 12:00 pm Location: UniversityofMiami,Miami,FL
The purpose of this course is to provide a review of how to verify hearing instrument fittings using validated fitting prescriptions in a short amount of time. Real ear and coupler based fitting terminology and techniques will be reviewed and demonstrated. In addition, demonstrating the benefit of advanced hearing aid features such as directionality, noise reduction and compression will be covered.
FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE | 11
Attend One or Attend All – FREE for Florida Academy of Audiology Members! $50 for Non-Members
Announcing the FLAA CEU Blitz!
You heard correctly! In preparation for licensure renewals, Florida Academy is kicking on this year with a CEU Regional Blitz in the month of February. Four great programs developed by four great sponsors.
Note: All Regional Programs are for 3 Hours of 0.3 CEUs. A light continental breakfast will be provided at each meeting.
To register, visit www.floridaaudiology.org and click on“UpcomingEvents.”Formoreinformation,[email protected].
01
02
12 | FLORIDA ACADEMY of AUDIOLOGY AUDIOLOGY ADVOCATE
FLAA NORTHEAST REGIONAL PROGRAM SponsoredbyTele-Acoustics
Audiology for the 21st Century: Maximizing Efficiency Through Innovative Technology
Date: Friday, February 15, 2013 Time: 8:00 am – 12:00 pm Location: CourtyardbyMarriottTampaDowntown,
Tampa, FL
External influences such as governmental regulations and changes to reimbursement for audiologic services play a key role in shaping Audiology in the 21st century. To survive and compete in today’s environment, Audiologist are forced to do more with less. Utilizing new technology improves the overall efficiency and patient throughput. Both, the new PC enabled audiometer –GSI AudioStar Pro and new auditory brainstem stimulus – CE Chirp will be presented as examples of new technology that can be used to save our most valuable commodity – time!
FLAA SOUTHWEST REGIONAL PROGRAM Sponsored by Siemens
Latest Advancements in Hearing Aid Technology and Applications to Increase Patient Satisfaction
Date: Saturday, February 23, 2013 Time: 9:00am–12:15pm Location: CourtyardbyMarriott,Ft.Myers,FL
There are so many new advancements in hearing aids that it can be difficult to discern which is most appropriate and most important for a particular patient. This session will include information on the features of learning and acclimatization, frequency compression, tinnitus therapy signals and their applications. Advancements in digital signal processing, particularly directional microphones and noise filters working in unison, as well as advancements in nanotechnology, smart receivers and robust housing will also be discussed.
03 04
Announcing the FLAA CEU Blitz! continued
Call for Papers
2013 Florida Academy of Audiology Convention
August 8-10, 2013 Hilton Orlando Bonnet Creek – Orlando, Florida
Participate as a guest speaker during our 2013 Annual Convention! We are accepting proposals for a variety of topics as diverse as our membership. (Proposals submitted to the academy should not be for the promotion of specific commercial products.) Title of Presentation: ___________________________________________________________ Presenter Name(s): ____________________________________________________________ Address: _____________________________________________________________________ City: _____________________ State:_____ Zip: ______________ Phone: _______________ Fax: ______________________________ E-Mail: ___________________________________ Length of Presentation: _________________________________________________________ Presentation Style: ___Classroom __ Roundtable ___Hands-on Workshop PLEASE SUBMIT THIS COMPLETED FORM, WITH THE FOLLOWING INFORMATION:
A brief abstract (100 words). This will be used to prepare a description of your presentation.
A brief biographical sketch of the presenter(s). This will be used to introduce the
presenter.
Learning outcomes for the presentation. These should NOT use the words "learn" or "understand" since these cannot be quantified.
Submissions can be made via email or by mailing the above material in Microsoft Word format, with this form, to the address below. Mailed submissions must be in CD format. Questions? Contact Executive Director Rachel Brooke at 561-414-0675.
Deadline for Submission is March 1, 2013.
Florida Academy of Audiology PO Box 8685
Delray Beach, Florida 33482 [email protected]
Fax 561-894-2281
2013 Florida Academy of Audiology Member Application/Renewal
Membership: Type: New Member Renewal (no break in membership) Category: Fellow Member ($150) Associate Member ($100) Student Member (Free) The Florida Academy of Audiology grants FREE Membership to unlicensed students enrolled in Florida Universities pursuing their Audiology degree. A Student Membership Application must be filled out every year for the membership to be considered active. Student Code (required for student membership): ______________________ Contact Information: First Name: ____________________ Last Name: _______________________ Dr. Mr. Mrs. Ms. Miss Company/Organization/University Attending: ________________________________ Business County:______________ Position: ____________________________________________________________________________________ Please check preferred address: Home Business Street Address: ________________________________________________________________________________ City: _______________________________________ State: ___________ Zip Code: _____________________ Preferred Phone: _________________________ E-mail address: ____________________________________ Professional Setting (Please Check One): Hospital/Clinic Institution Private Practice Public/Private School Other Other Memberships: AAA ASHA ADA FLASHA OTHER: _________________________________ ***If you are currently a FLASHA member, you may be eligible for a one-time 20% discount when you join FLAA for the first time. Please contact our headquarters for more information at 561-414-0675 or [email protected]. Communications: I hereby release rights to photographs, video and statements taken by Florida Academy of Audiology to use in possible promotional or
educational materials, publications, and including FLAA's web site. I would like to receive communications from FLAA and other parties that FLAA is in cooperation with regarding continuing education and
job postings. Agreement: By submitting this form and my payment to the Florida Academy of Audiology, I agree to abide fully with the Florida Academy of Audiology Code of Ethics, which can be viewed on the Academy's website at www.floridaacademy.org. Fellow Members, only: I certify that my Florida state audiology license is current and in good standing and that my Florida State License number is _______________________________. Please include a copy of your State License with this application.
____________________________________________________________ Applicant Signature (application will not be processed without it)
Contribution to Lobbying Costs: Please select a contribution amount, or designate any other amount that you would like to give. No amount is too small or too large! Please note that contributions to the Florida Academy of Audiology are not deductible as charitable contributions for federal income tax purposes. Please consult your personal tax advisor for how this contribution may affect your individual circumstances. Contribution Amount: $25.00 $50.00 $100.00 $200.00 $500.00 Other: _____________ Do we have permission to recognize your contribution in future materials? Yes Yes (but not the amount) No
Payment (No payment required for Student Membership with Code verification):
Payment Method: Visa Mastercard American Express Check #: ______________ Credit Card Number____________________________________________ Expiration Date________________ Name on Card ____________________________________________ V-Code (digits on back of card)___________ Authorized Signature______________________________________________ Date _________________________ An important update regarding the Tax Deductibility of your FLAA Dues: Dues for membership to FLAA are not deductible as charitable contributions for federal income tax purposes but may be deductible as an ordinary and necessary business expense. Pursuant to Sections 162 (c) and 6033 (e) of the Internal Revenue Code, certain lobbying and political expenses are not deductible and information concerning their non-deductibility must be communicated by tax-exempt organizations to their members. In compliance with these requirements, you are hereby notified that 52% of your dues and any contribution to the PAC are not deductible. Mail/Fax Payment to: Florida Academy of Audiology | PO Box 8685, Delray Beach, FL 33482, (561) 894-2281 FAX
Hilton Orlando Bonnet CreekOrlando, Florida
Save the Date: August 8–10 2013 Annual Convention
FLORIDA ACADEMY of AUDIOLOGYPO Box 8685Delray Beach, Florida 33482(561) 414-0675 [email protected]
