Contact Information
Name*
Title
Company
Address*
Email*
Mobile Phone Number
Due to COVID safety precautions, we are shifting completely to digital registration to help reduce the amount of contact onsite. Please provide your mobile device number below help facilitate that effort. By entering in your mobile phone number, you agree to receive messages via SMS/MMS regarding Abilities Expo.

Demographic Information

If you require accommodations for a disability to participate at the Expo (such as American Sign Language interpretation, Braille, electronic format, etc.), please indicate as many as apply below before June 3, 2022.
American Sign Language Interpreter
Real–Time Captioning/CART (applies to workshops only)
Large print
Other
Please Specify:
*Are you a healthcare professional?
Yes
No
*How did you find out about Abilities Expo? (Check all that apply.)
Postcard (Direct Mail) Social Media
Billboard (Outdoor) Chicago Tribune
Daily Herald Streaming Television
Text message Radio: WBBM Newsradio
Mobile device ads Magazine
www.abilitiesexpo.com Other Website
Non-profit Organization Abilities Buzz E-newsletter
Email Flyer
Abilities Expo Ambassador Friends/Family/Acquaintance/Co-worker
Other
Please Specify:
If you heard about Abilities Expo through social media, check all that apply. (Check all that apply.)
Facebook
Twitter
Instagram
Youtube
LinkedIn
Other social media
Please specify which social media other than the ones above:
*Are you a person with a disability?
If yes, is the disability: (check all that apply)
Mobility Upper Limb Amputee
Lower Limb Amputee Vision
Hearing Developmental
Autism Spectrum Disease/Illness
Cognitive Sensory
Other
Please Specify:
If you are not a person with a disability, are you a...?(check all that apply):
Friend/Family Member
Caregiver
Healthcare/Disability Professional
Dealer/Distributor
Manufacturer
Other
Please Specify:
*Have you attended a past Abilities Expo?
Yes, I have attended.
No, I have not.
*Why did you decide to visit Abilities Expo? (Check all that apply.)
Latest disability products and services
Informative workshops
Adaptive activities like sports, dance and more
Networking
Other
Please Specify:
*What is your gender?
Male
Female
Other
Please Specify:
*What is your age?
*In the next 12 months or sooner, do you intend to purchase any of the following? (check all that apply)
AAC device Accessible Vehicle
Adaptive Clothing Assistive Technology
Daily Living Aids Deaf/Hard of Hearing
Healthcare Provider/Equipment Home Medical Equipment/Furnishings
Lift/Ramp Low Vision/Blind
Pediatric Equipment Scooters/Accessories
Service animal Sports/Fitness/Recreation
Therapies Travel
Walker/Cane/Crutch/Accessories Wheelchair (Manual)/Accessories
Wheelchair (Power)/Accessories Just browsing
Other
Please Specify:
Click here if you would prefer NOT to receive the Abilities Buzz, an e-newsletter that conveys valuable information about people with disabilities and Abilities Expo events.
No, I do not wish to receive the Buzz.
 
 
 
 

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