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'Hearing Matters' Public Panel application. 
If you are interested in joining the BIHIMA 'Hearing Matters' Public Panel, please fill in a few details below and a member of the team will be in touch.
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Email *
What is your full name? *
Do you have a preferred name for correspondence?
Why would you like to join the 'Hearing Matters' Public Panel? *
How long have you been wearing hearing instruments? *
Where do you currently live? *
What are your pronouns? *
What is your email address? *
Where did you hear about the public panel? *
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