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begins with
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Last name
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does not contain
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not empty
begins with
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Phone
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empty
not empty
begins with
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Preferred Email
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does not contain
is not
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not empty
begins with
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Birthdate
on or before
is
on or after
empty
any date
this month
this year
last month
last year
next month
next year
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February
2026
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Ohio License Number
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does not contain
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begins with
ends with
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New or Returning Member?
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is not
New Member
Returning Member
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Business Address
contains
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does not contain
is not
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not empty
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Business City
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Business State
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Business Zip Code
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is not
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*
*
Business Phone Number
greater than or equal
less than or equal
equal to
not equal to
*
*
Business Fax Number
greater than or equal
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equal to
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Business Email
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is not
empty
not empty
begins with
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I am a:
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Practice Sole Owner
Partner
Employee
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Level of Education
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is not
High school diploma or equivalent
Some college
Undergraduate degree
Masters degree
Doctoral degree
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I am board certified by:
any of selected
all of selected
none of selected
NBC-HIS
AAA
N/A
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I am a licensed:
any of selected
all of selected
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Hearing Instrument Specialist
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