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ASET Grassroots Census
Advocacy > Grassroots Campaign

STAND UP AND BE COUNTED

Part of ASET's mission is to advocate for professional excellence and quality patient care in neurodiagnostics. As we all know, when it comes to advocacy the number of voices counts. Please complete this brief census form so you, too, can be counted and included in our efforts to build a great interstate communications system across our Nation!

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Aset ID#
First Name *
Last Name *
Employer *
Street Address *
City *
State *
Zip/Postal Code *
Country *
Primary Phone *
Email Address *
Primary Occupation *
Other

Please provide us with your home address rather than work address so that we may cross reference our neurodiagnostic census with the U.S. census and congressional districts.

Thank you for participating in ASET's Grassroots Census project! Upon submitting this completed form, you will be directed to your complimentary download and additional information about ASET's Grassroots Campaign and ways you can help advance the neurodiagnostic profession.

Please select which downloads you would like and click the submit button at the bottom of the screen.
Complimentary Download [Select one or more]
To select more than one download, please hold your Ctrl (PC) or Command (Mac) key while selecting.
Yes! Please notify me by email about ASET's advocacy efforts and other hot topics.
Enter Text Below:

Your form submission WILL be encrypted using SSL to ensure your privacy.