CHIPS Membership Application Form

Thank you for applying for CHIPS membership!

The CHIPS membership runs on the calendar year, January through December, no matter what time you join. That means your membership won’t expire until Dec. 31, 2021.

If you have any questions about CHIPS membership or this form, please email us at, or call us at 734.522.7200 and ask for Esther or Elizabeth to assist you.

Complete the form below to apply for your joint CHIPS membership.

Please type "I am not a dispenser" if this does not apply to you
If you are not licensed, please type "Not Licensed" in the field above.
  • Professional : Individuals engaged in the practice of testing human hearing and selecting, fitting and dispensing hearing instruments, and counseling patients.
  • Industrial : Individuals engaged in the hearing aid industry, but not necessarily involved in all phases of the practice of testing human hearing and selecting, fitting and/or counseling and dispensing hearing instruments.
  • Affiliate/Associate : Office staff, receptionists or any other support staff, educators, physicians, counselors or those employed by a hearing industry manufacturer or supplier.
  • Student : Individuals pursuing an academic or vocationally-based program of study in the practice of hearing instrument sciences or other related professions.
$ 0.00