AVI Guest Book

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Thanks for visiting! We would love to hear from you! Please fill in any information below you would like to share… Please be aware that any information you submit over the internet via this form is insecure and could be observed by a third party while in transit. All information is for AVI use only. Thank you for signing our on-line Guest Book, and please come back!

Please tell us your name:
Address:
City/State/Zip:
Country:
Phone:
Your E-mail address:
Are you currently an AVI Member?        Yes        No
Would you like membership information sent to you?        Yes        No (Click here for membership information)
Other information (For AVI use only.  Check all that apply)        Adult Who is Hearing Impaired        Parent or Guardian of a Child Who is Hearing Impaired        Grandparent of a Child Who is Hearing Impaired            University/College Student        Audiologist        Auditory-Verbal Therapist        Speech-Language Pathologist        Teacher of the Hearing Impaired        Physician        Other (please specify)     
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