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Personal Data

First Name:

Last Name:

Title:  Mr. Mrs. Dr. Prof.

Job Function

Chief-level officer/president
Accessibility Expert
Business decision maker
Software Engineer
Financial decision maker
Researcher
IT decision maker
IT training, instruction, and support
Other (please specify)

Organisation

Organisation Name:

Organisation type:
Telecom. Equipment Manufacturer
Mobile Device Manufacturer
PC Operating System Developer
Telecommunications operator
ICT Application Developer
Content Provider/Aggregator
Vehicle Manufacturer
Domotics Implementer
Mobility Impaired Association
Standardisation Body
Venture Capital
Goverment-National or Local
European Commission
Research
Media and Press
Education
Other (please specify)

Address

Postal Address:

City:

Postal Code:

Country:

Phone number:

E-mail address:

Optional Information*

(fax no, expertise, etc...):

Please note that all fields are obligatory except optional information