LookTel Beta Program Sign-up Form

* Full Name:

* Email Address:

* Best Phone Number(s):

* Best times to contact you by phone:

* Location (city, state, province, and country):

* Time zone:

* My interest in LookTel products is:

* What cell phone or other iOS device are you currently using?

* What are the 3 adaptive technologies most important to you that you use frequently?

* I am interested in LookTel products because...

* Age:

* Gender:

* Number of years of vision loss:

* How do you rate your own knowledge of adaptive technologies that you use? 1 = Novice to 10 = Expert

* Do you own and use a Mac?:

* If so, what model, and approximately how old is it? What OS does it have running?

* Is your Mac your primary computer?

* Does your Mac have a camera?

* What are the primary uses for your Mac?

* Please verify that you are a human by answering a simple question. What is 2 + 3:

Privacy Notice: All submitted information will be kept confidential and will not be released to any other parties