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ATIA Membership Application

Member Directory Profile Information

This information will be displayed on the online searchable Member Directory that is available to the public. ATIA's membership year is from January 1st - December 31st.

Company Name*

Street Address*

Street Address Line 2

City*

State/Province

Other State/Province

If your state or province isn't listed in the dropdown above.

Zip/Postal Code*

Country*

Main Company Phone Number*

800 Number

General Company E-mail Address*

Website*

Company Logo*

Upload company logo to be displayed in Directory. (File formats .jpeg and .png are accepted.)

Accepted file types: jpg, jpeg, png, Max. file size: 3 MB.

Company Description*

Enter a description to be displayed in Directory.

0 of 400 max characters

Company Technology and Business Areas of Focus for Directory search options. Please select all that apply.

Disability*

Blindness

Cognitive

Communication

Deaf/Hard of Hearing

Learning

Low Vision

Mobility

Physical

Other

Other Disabilities

Please enter as a comma-separated list.

Age / Population*

Early childhood

School

Higher education

Post-Secondary

Adult

Senior / Aging

Other

Other Ages / Populations

Please enter as a comma-separated list.

Environment*

Academic Institution

Accessibility

Home

Hospital

Independent Living

Rehabilitation

School

Web accessibility

Work

Other

Other Environments

Please enter as a comma-separated list.

Contact Information

This information will not be displayed in the public Member Directory. Contact information will be used for communications on member topics such as renewal, news and other member programs.

Primary Contact Information

The Primary Contact is responsible for member renewal.

First Name*

Last Name*

Title*

Email*

Your email address will be your username.

Password*

Enter Password Confirm Password

Phone Number*

Contacts

CEO/President or similar role

First Name*

Last Name*

Title*

Email*

Phone Number*

VP/ Director Sales or similar role

First Name

Last Name

Title

Email

Phone Number

VP/ Director Marketing or similar role

First Name

Last Name

Title

Email

Phone Number

VP/ Director Training or similar role

First Name

Last Name

Title

Email

Phone Number

Events Manager/ Coordinator or similar role

First Name

Last Name

Title

Email

Phone Number

Do you have policy contacts?

Yes

No

Policy Contact 1 First Name

Policy Contact 1 Last Name

Policy Contact 1 Title

Policy Contact 1 Email

Policy Contact 2 First Name

Policy Contact 2 Last Name

Policy Contact 2 Title

Policy Contact 2 Email

Policy Contact 3 First Name

Policy Contact 3 Last Name

Policy Contact 3 Title

Policy Contact 3 Email

How did you hear about ATIA?

Conference

ATIA Staff

Web site

Email

ATIA Member

If you were referred by an ATIA Member, please provide us with more details to we can pass on a referral thank you reward.

Referral Contact Name

Referral Company Name

What specific goals do you hope to achieve through your ATIA membership?

What is the most valuable member benefit to you?

Conference booth discounts

The opportunity to present at AT Demo Days

Complimentary access to the ATIA Learning Center – with 175+ online courses with CEUs

Members-only webinars and conference calls

Marketing opportunities: conference, online member directory and more

Join ATIA Policy Committee – with weekly updates and monthly calls to keep abreast of the latest policy developments

Networking opportunities

What do you find valuable about the member benefit you selected?

What industry-specific advocacy or policy initiatives are important to you?

Comments / Notes

Membership Options*

Small Company Regular Membership - Annual Revenues under $500K - $650

Regular Membership - Annual Revenues of $500K - $99M - $1,250

Regular Global Membership - Annual Revenues over $99M - $4,600

Associate Distributor * - $200

* Members at the Associate level do not carry association voting privileges and are ineligible to serve as Board Directors.

Premier Listing

Upgrade my listing to a premier listing +$1,000.00

Premier listing positions your company listing at the top of the member directory attractively highlighted as a boxed listing. Learn more.

Promotion Code

Payment Information

Please note that if you are using a payment method other than credit card, you will receive instructions via e-mail on how to submit payment and your membership will not be approved until payment has been received. For any questions on the status of your membership application, please contact membership@atia.org.

Payment Method

Credit Card

International Wire Transfer/ACH

Payment Details

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Total

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Member Info and Benefits

Member Login
New Member Application
Premier Listing Sponsorship
Exhibit at ATIA 2026
Feature Your AT Product at Demo Days
ATIA YouTube Channel

Facebook
Instagram
LinkedIn
YouTube

Contact Us

Assistive Technology Industry Association (ATIA)
1061 American Lane
Schaumburg, IL 60173-4973 USA

Toll-Free: 877-OUR-ATIA (687-2842)
E-mail: info@ATIA.org

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