* 1. Which of the following describes you? (Check all that apply.)

* 2. Please choose which age group you and/or your family are the most passionate about regarding issues that impact those with differing abilities. (You may choose more than one.)

* 3. What issues faced by people with differing abilities are you most concerned about? (You may choose more than one.)

* 4. Do you currently receive information from advocacy groups?

* 5. Would you like to receive information on ways that you can help us advocate about critical issues that affect those with differing abilities?

* 6. How do you prefer to receive information?

* 7. Do you have a Facebook account?

* 8. Do you prefer other forms of social media?

* 9. Thank you for your time and your insights. Please provide any additional comments here.

* 10. If you would like information about advocacy issues and events, please leave your name and email address below.

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