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3. Phone Number
4. Street Address
5. Country
6. City
7. Zip code
8. Organization
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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. 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
12. Please indicate your interest areas in Assistive Technology: Check all that apply
13. Have you participated in any of the following ATIA activities? (select all that apply)
14. Badge ID
15. Country (eShow)
16. State (eShow)
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