Please complete this survey and submit. This is a secure form.

Your feedback will help us advocate in Washington, D.C. to change policies to help improve your mobility and independence.

Questions with asterisks require responses.

* 1. Please provide your name:
(We would like to follow up with you if we have any questions.)

* 2. Please provide your email and/or phone number:
(We would like to follow up with you if we have any questions.)

* 3. Please provide your state:
(We would like to know locations of access problems so that we can share with the right elected officials).

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