Contact Information
Name*
Title
Company
Address*
Email*
Phone Number

Demographic Information

*Are you a healthcare professional?
Yes
No
*How did you find out about Abilities Expo? (Check all that apply.)
Postcard TTC Subway Posters
Toronto Sun Outspoken Magazine
Radio: Q107 FM Radio: Talk Radio AM 640
Radio: Newstalk 1010 Television commercials
TDC: The Disability Channel Mobile Device Ads
www.abilities.com/toronto Facebook
Twitter Other Social Media
Other Website Non-profit Organization
Abilities Buzz E-newsletter Email
Flyer Abilities Expo Ambassador
Friends/Family/Acquaintance/Co-worker Other
Please Specify:
*Are you a person with a disability?
Yes
No
If yes, is the disability: (check all that apply)
Mobility Vision
Hearing Developmental
Autism Disease/Illness
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
Other
Please Specify:
*What is your age?
*What is your gender?
Male
Female
Gender Neutral
*Where is your primary residence?
Central Toronto
East Toronto
West Toronto
North Toronto
GTA
Other
Please Specify:
*Why did you decide to come to Abilities Expo? (Check all that apply.)
Latest disability products and services
Informative workshops
Service dog demo
Interactive, adaptive activities like sports, dance and more Networking
Other
Please Specify:
*In the next six months, do you intend to purchase any of the following? (check all that apply)
Adaptive Vehicle
Manual Wheelchair
Power wheelchair
Other wheelchair products
Adaptive sports equipment
Lifts / Ramps
AAC devices
Service animal
Just browsing
Other Products
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.
*Abilities Expo may share our attendee list with our Exhibitors. Do you consent to having your email address shared?
Yes
No

There are errors in your form, see details above!

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