Cogentica Registration

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Though subject to change, the primary purpose of the disability registry is to have a listing of disabled individuals who we can contact to participate in survey and marketing studies that are useful to the disability community. All solicited information is voluntary and you can skip any fields you are uncomfortable completing. Needless to say, all your responses are completely confidential and will not be released with any identifying information. At a minimum, please provide your email, zip code, age, gender, and disability category.

Age Category
Disability Category
The disability categories are useful should we seek to select individuals for participation in surveys or marketing studies. Please select all categories that are relevant.