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New User Registration
Please provide the following information about yourself. Required fields are marked with a red star (
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Email Address:
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Email Address (reenter):
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Password:
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Password (reenter):
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First Name:
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Last Name:
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Telephone:
Date of Birth:
Disabilities:
Alcohol Dependence
Autism
Behavioral/Emotional Disorder
Cerebral Palsy
Chronic Medical
Dementia
Extreme Maladaptive
Fetal Alcohol Syndrome
Hearing Impairment
Learning Disability
Mental Illness
Mental Retardation
Neurological Impairment
Non-Mobile
Prader-Willi Syndrome
Seizure Disorder
Speech Impairment
Substance Abuse
Unknown
Vision Impairment
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Use this box to search for people who advocate for you and have already signed up with BackInUse. Only you can authorize someone to act on your behalf on BackInUse.
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Your Privacy is Important to Us
Information provided to BackInUse.com will be used only for the purposes of exchanging equipment on the site and for reporting as required by funding agencies. This reporting will not identify specific individuals but will only identify equipment categories and equipment locations. Your email address and phone number will never be provided to any third-party group or individual.
