Membership

MAA applicationIf you are a licensed Audiologist in the state of Maine, please join our Academy. New and renewing members can register below and pay online by credit card or download and print an application form here.

     

    To Register Online:

    First Name (required)

    Middle Name or Initial

    Last Name (required)

    Renewal and New Members:

    • Please update the information below.
    • Please indicate preferred address to receive Academy information.

    Business Address:

    Business Phone

    Business Email (required)

    Home Address:

    Home/Cell Phone

    Home Email

    NOTE: The MAA sends most correspondence to members via email.

    Please indicate your correspondence preference below:
    emailpostal mail

    And do you prefer receiving MAA correspondence at your business or your home address?
    businesshome

    Do you currently hold a license to practice audiology?
    yesno

    Has your license ever been suspended or revoked by any state? If yes, please explain in the additional comments box below.
    yesno

    Are you currently under investigation for suspension of license?
    yesno

    I have read and agree to abide by the MAA By-laws and Code of Ethics.
    (If you need a copy of these documents please contact the current MAA President.)
    I have read and completed this application and I attest that all the information and supporting documentation are true to the best of my knowledge.

    Additional Comments?