ADA National Network Learning Session:
The Basics of Health Care and the Americans with Disabilities Act (ADA)
Registration Form

This webinar will be 90 minutes long and will begin at at ET: 2.30pm, CT: 1.30pm, MT:12.30pm, PT:11.30am, Hawaii: 9.30am during mainland Standard Time; 8.30am during mainland Daylight Savings Time.

You will receive a confirmation email with more webinar details after October 1st, 2023

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* 1. Webinar Participant Contact Information:

First Name

Last Name

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* 2. Organization Information:

Organization name

State

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* 3. Do you require any accommodations?
(All accommodation requests must be received by October 20, 2023.)

Yes

If "Yes", please specify the accommodation(s) that are required.

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* 4. What role best describes you? (Choose all that apply)

ADA Coordinator

Business

Employer

Family Member of Person with a Disability

Individual with a Disability

Health Care Provider

State/Local Government Agency

None of the above

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* 5. Would you like a Certificate of Attendance emailed to you?

Yes

ADA National Network Learning Session: The Basics of Health Care and the Americans with Disabilities Act (ADA)Registration Form

Question Title

* 1. Webinar Participant Contact Information:

Question Title

* 2. Organization Information:

Question Title

* 3. Do you require any accommodations? (All accommodation requests must be received by October 20, 2023.)

Question Title

* 4. What role best describes you? (Choose all that apply)

Question Title

* 5. Would you like a Certificate of Attendance emailed to you?

ADA National Network Learning Session:
The Basics of Health Care and the Americans with Disabilities Act (ADA)
Registration Form

* 3. Do you require any accommodations?
(All accommodation requests must be received by October 20, 2023.)