Walk4Hearing is May 18, 2024!

BOT Application Form

    Your Name (required)

    Your Email (required)

    Street Address



    Daytime Phone

    Evening Phone

    Indicate V, TTY, VCO or relay numbers

    HLAA Affiliation: Number of Years HLAA National member - Must be current

    HLAA Chapter Affiliation: Number of Years HLAA chapter member

    Office(s) held:

    Please Provide a short biography:

    If you are elected to the HLAA-MI Board of Trustees, what talents do you bring with you. Examples might be; proficiency with Microsoft Office products, graphics design, grant writing, marketing, advertising, teaching,Hearing Assistive Technology(HAT), prior board of director experience at a non-profit, etc. Please list all.


    Form Updated Sept 2016