Auditory-Verbal International, Inc.® (AVI)

1390 Chain Bridge Road
McLean, VA 22101
(703) 739-1049

Dues Notice
Important Note: The membership year runs on the calendar year. If you have already paid your membership dues for the year or are an AVI Lifetime Member, please so indicate and include name, current address, phone number, e-mail address and return to AVI!  (This helps ensure the accuracy of our records—Thank you!)

Membership Dues (Payment in Full Required; US currency ONLY)

United States $50.00 International $60.00 Lifetime $500.00
Canada/Mexico $55.00 Corporate $1500.00 Student $30.00*
*Membership form must be accompanied by a letter from advisor on University Stationary.
Gift Membership (Makes a great gift!)

City, State/Province, Zip:  
United States $50.00


Canada/Mexico $55.00


Donation (Tax deductible, Thank you!!!)


In Honor of:          In Memory of:           


(Please enclose or provide credit card information below)         TOTAL AMOUNT:

Other information (Check all that apply)

Audiologist Cert. AVT AVI Parent
Teacher of The Hearing Impaired AVI Friend AVI Grandparent
Speech Language Pathologist
Current Contact Information

City, State/Province, Zip: 
Phone (H):  Fax: 
Phone (W):  E-mail: 
Method of Payment Check Money Order Visa Mastercard
Name on card: 
Card Number: 

Expiration Date:  

I specifically authorize AVI to charge my credit card all charges indicated on this form.

Signature:                                                                                                  Date:

Cert.AVTs Note:  This invoice is for AVI MEMBERSHIP ONLY.  Invoice for annual Cert.AVT Fee will follow under separate cover.  You must be an AVI member to receive The Auricle, conference discounts, etc.

Copyright � 2000-2002 Auditory-Verbal International, Inc.® All rights reserved.
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