Contact Information
Name*
Title
Company
Address*
Email*
Mobile Phone Number
All registration is digital to help reduce the amount of contact onsite. Please provide your mobile device number below to 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 12, 2024.
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
X (Formerly 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, 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.
 
 

 

 

 

 

 

 

 

 



Privacy: Abilities Expo does not sell or share your contact information. We will use it to keep you informed about Abilities events in your area, as well as important disability-focused issues and products.

Photographs/Videos: By registering for this event, attendees and their guests understand that Abilities may take photographs/video of them, and any photographs/video taken by show management during the Expo may be used for future promotions and communications.

Visas: Abilities Expo is free to the public and all are welcome. For potential international visitors you're also very welcome, however, we are unable to issue letters of invitation for the purposes of securing a Visa into the United States.

Disclaimer: The inclusion of any advertising, photographs, likenesses, logos or website links provided by any third-party on any www.abilities.com or Abilities Expo or any other 5NET4 Productions (hereinafter referred to as Abilities) websites, or in any Abilities electronic or print publications, newsletters or other related materials are provided by Abilities for your convenience only. Any statements and/or claims made in such advertising or third party materials are solely that of the entity purchasing booth space and/or digital or print advertising space and is the author of such materials. Abilities does not evaluate any exhibitor or advertiser products or services nor do they assess any promotional claims.

Neither the appearance of any products or services at any Abilities shows, Websites, publications or newsletters, nor reference to any products or services therein, shall in anyway whatsoever constitutes a guarantee, warranty or endorsement by Abilities of the quality, merchantability, functionality or value of such products or services, or of any claims made by the manufacturers, retailers or representatives of such products or services.


There are errors in your form, see details above!

Powered by TPNI - The Pulse Network - www.tpni.com