On the Menu - Hear & Be Heard

DOROT Westchester

invites you to join us for

On The Menu: Hear & Be Heard

"On the Menu" offers a warm and informal setting for learning, discussing, and reflecting on topics connected to aging well.

Join us for a conversation on hearing health and aging.

We will explore common causes of hearing loss, devices and support available today, and how hearing changes can affect relationships and daily activities.

Add your thoughts and experiences to the information presented by Kristi D’Auria, AuD, CCC-A, Supervisor of Audiology at the Westchester Institute for Human Development.

Wednesday, April 29th

2pm - 3:30pm

DOROT Westchester

925 Westchester Ave. White Plains, NY

This program is for adults 60+

Registration required.

Please complete this form.
Name *

First NameLast Name
Gender Identity*
Preferred Email*
example: infowestchester@dorotusa.org
Email for Reminders:
IF OA registers by PHONE but does provide an email for SF account.
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Format: (000) 000-0000.
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Secondary Phone #
Format: (000) 000-0000.
Secondary phone type:
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Zip Code*
Address*

Street Address

Street Address Line 2

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Birth Year*
This program is for adults 60+
Birth Month
Birth Day
Terms of Participation:
Terms of Participation:

Before we finish your registration, I need to read you a brief statement about program content. This is the same agreement participants see when registering online. It explains that all program materials belong to our organization and can’t be used or shared without our permission. After I read it, I’ll ask if you agree so we can complete your registration.
The content of this program is the property of DOROT, Inc. and is intended solely for the personal, non-commercial use of authorized participants. All rights are reserved. Any recording, screen scraping, copying, storage, display, or distribution of this content without DOROT, Inc.'s express written permission is strictly prohibited. Unauthorized use may subject violators to civil and criminal penalties.*

I agree to these terms.
DOROT staff, read this to participant: The content of this program is the property of DOROT, Inc. and is intended solely for the personal, non-commercial use of authorized participants. All rights are reserved. Any recording, screen scraping, copying, storage, display, or distribution of this content without DOROT, Inc.'s express written permission is strictly prohibited. Unauthorized use may subject violators to civil and criminal penalties.*

DOROT STAFF read this as part of the registration by phone and VERBAL AGREEMENT was received.
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Please check your responses carefully for accuracy. You will not be able to revise this form after submission.
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Terms of Participation:

Terms of Participation: