Online ACDIS local chapter roster

Please tell us which ACDIS local chapter you belong to (or wish to join) and complete your contact information below.

*Please note: ACDIS does not sell the local chapter roster to any third parties.
1.Please select your ACDIS local chapter or networking group (note: the name of your chapter or topic-based networking group may be the same as your state or may be specific to your region, please select the chapter you wish to join):(Required.)
2.Please complete your contact information.(Required.)
3.What is a secondary email address that may be used to contact you?(Required.)
4.Which best represents your reason for filling out the local chapter roster?
5.Are you an ACDIS member?
(Required.)
6.Are you willing to present at a local chapter meeting?(Required.)
7.Are you willing to host chapter meetings at your facility?
(Required.)
8.Are you interested in serving in an officer/leadership role?(Required.)
9.Please indicate your title/role:
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