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.

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 4, 2021.
American Sign Language Interpreter
Real–Time Captioning/CART (applies to workshops only)
Braille
Large print
Electronic Format
Other
Please Specify:
*Are you a healthcare or disability 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 Family Time Magazine
TV: WGN 9 Chicago Text message
Radio 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
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:
*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:
*Have you attended a past Abilities Expo?
Yes, I have attended.
No, I have not.
*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.
 
Abilities Expo COVID-19 Requirements and Release

Enhanced Safety and Health Measures:
Attendance at or participation in the Abilities Expo is subject to the release below, and compliance with Abilities Expo and the conference and event facilities’ policies and procedures to implement current CDC and applicable state’s recommendations, which include, but are not limited to, wearing a mask unless you can provide medical documentation explaining why you cannot wear one, physical distancing, retreating immediately if feeling unwell or showing certain symptoms.

Release:
I hereby release, covenant not to sue, discharge, and hold harmless Abilities Expo and its affiliates, including their respective employees, officers, directors, agents, and/or representatives, from any claim or cause of action, including all liabilities, penalties, losses, damages, costs, or expenses of any kind, arising out of or relating to exposure to COVID-19. I agree that the foregoing release, discharge, and covenants apply even when Abilities Expo or its affiliates directly or indirectly caused injury, losses, or other harm related to COVID-19, whether by acts or omissions, and whether a COVID-19 infection occurs before, during, or after participation in in any Abilities Expo (or affiliate) program. This release is binding on my heirs, administrators, executors, successors and assigns.

Agreement to Abilities Expo Policies:
Selecting agree below, you indicate I have read and agree with the terms in the Abilities Expo COVID-19 Requirements and Release, in addition to all other registration terms, conditions and policies.
I agree

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