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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. 2020 - Marketing Opt Out: ATIA will be sharing basic attendee data with our members companies who have sponsored activities. Please indicate if you would like to withhold your information from sharing with our members. We will be sharing the following data: Name, title, workplace, email, and interest areas.
12. 2021 Marketing Opt Out: ATIA will be sharing basic attendee data with our members companies who have sponsored activities. Please indicate if you would like to withhold your information from sharing with our members. We will be sharing the following data: Name, title, workplace, email, and interest
13. Marketing Opt Out: ATIA will be sharing basic attendee data with our members companies who have sponsored activities. Please indicate if you would like to withhold your information from sharing with our members. We will be sharing the following data: Name, title, workplace, email, and interest
14. Please indicate your interest areas in Assistive Technology: Check all that apply
15. Have you participated in any of the following ATIA activities? (select all that apply)
16. Badge ID
17. Country (eShow)
18. State (eShow)
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