Announcing our new Hearing Ambassador Club!

Many of you have asked if there is any program available that will allow you to get special discounts on products and services for your hearing instruments. Now there is! We are proud to announce the formation of the Hearing Ambassador's Club.

As an Ambassador Club Member you will receive your next year's "Battery Mart" renewal free, enabling you to purchase batteries for $2.49 per package. You will also be entitled to a ten percent discount on all hearing instrument repairs, extended warranty renewals and all items, except batteries, from the "hEar Shoppe" catalog. Best of all when you decide to upgrade to new hearing instruments, your ten percent discount applies to the purchase. There will also be opportunities to participate in contests and receive high quality prizes.

To become a Hearing Ambassador, fill out the form below. You may provide up to Three hearing instrument users and two non-users. Each user that you provide will receive a free one-year "Battery Mart" membership. Non-users will receive a free copy of the "hEar Shoppe" catalog and newsletter. You must provide at least 3 names to become a Hearing Ambassador. When you have completed the process, you will receive a certificate identifying you as eligible for all benefits.

Use the tabs below to show input form for each person.

Yourself

Inst. User 1

Inst. User 2

Inst. User 3

Non-user 1

Non-user 2

	Please tell us about yourself.
Your Name:	*Required
Your E-mail:
Address:	*Required
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	Yes, You may use my name.

	Hearing Instrument User #1.
Name:	*Required
E-mail:	*Optional
Address:	*Required
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	Hearing Instrument User #2.
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	Hearing Instrument User #3.
Name:	*Required
E-mail:	*Optional
Address:	*Required
City:	State: Select State Not In United States Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New HampshireNew Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip:

	Non-User #1.
Name:	*Required
E-mail:	*Optional
Address:	*Required
City:	State: Select State Not In United States Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New HampshireNew Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip:

	Non-User #2.
Name:	*Required
E-mail:	*Optional
Address:	*Required
City:	State: Select State Not In United States Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New HampshireNew Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip:

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