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, etc.), please indicate as many as apply below before April 14, 2023.
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
The Star-Ledger New York Daily News
Jewish Press Amsterdam News
El Diario Text message
TV: NBC, Channel 4 TV: New Jersey News 12
TV: Other Cable Stations WABC Radio
Mobile device ads Magazine
Abilities.com www.nj.com
Other Website Non-profit/Gov't. Organization
School 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.
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?
*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, do you intend to purchase any of the following? (check all that apply)
AAC devices Accessible Vehicle
Adaptive Clothing Assistive Technology
Daily Living Aids Deaf/Hard of Hearing Products
Healthcare Provider/Equipment Home Medical Equipment/Furnishings
Lifts / Ramps Low Vision/Blind Products
Pediatric Equipment Scooters/Accessories
Service animal Sports/Fitness/Recreation
Therapies Travel Service
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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