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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. ASHA Membership Number: If you have an ASHA membership number, please enter the # here. If not, please leave this field blank. Please note: You must enter your ASHA membership number to obtain ASHA CEUs for approved courses.

11.

I opt out of ATIA sharing my data

12. 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

13. 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

14. Badge ID

15. Country (eShow)

16. State (eShow)

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