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1. Time Zone

3. Phone Number

4. Street Address

5. Country

6. City

7. Zip code

8. Organization

9. Title

10. Do you have an ASHA membership number? If yes, please enter it here. Please note you must enter your ASHA membership number to obtain ASHA CEUs for approved courses.

11.

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12.

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13.

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14. Please indicate your interest areas in Assistive Technology: Check all that apply

Augmentative & Alternative Communication Blindness and Vision Impaired Deaf and Hearing of Hearing K-12 Education & Learning Higher Education Physical Access Workplace Accessibility Mainstream Software Accessibility

15. Have you participated in any of the following ATIA activities? (select all that apply)

I have attended the ATIA Orlando Conference in the past. I have used the ATIA Learning Center/Webinars in the past. I have been a speaker for an ATIA conference or online session in the past. I have participated in an ATIA Survey in the past. None of the above

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