PARTICIPANT
REGISTRATION  FORM
INSTRUCTIONS


ACCESSING SAFETY INITIATIVE
[MEETING TITLE]
[MEETING LOCATION]
[MEETING DATES]







CONTACT INFORMATION
We will be using the contact information you provide to update our records and communicate any information about the meeting.  Please complete every field.  If you do not have the contact information requested, please note “none” or “N/A” in the space provided.  Please do not leave any field blank.  

ARRIVAL AND DEPARTURE
Please provide us with your best estimate of the date you plan to arrive and depart. If this information changes when you make your air or ground travel arrangements, please notify Hilarie Ashton.   

ACCOMMODATION NEEDS
If you are requesting an ADA or Deaf/HOH room, please indicate the type here.  We need this information to help ensure that you get the accessible room you request.  Please note that this information is for verification purposes only and it is your responsibility to make your reservation with the hotel.  

MEETING NEEDS 
To meet your accessibility needs, we need to know the type of reasonable accommodation you require in advance.  While we will make every effort to fulfill reasonable accommodation requests on-site, we cannot guarantee them.  Please complete this section to ensure that your accessibility needs are met.

Please note that reasonable accommodations will be provided during meetings session and during meals.  For referrals for assistance outside of this time, please consult the attached resource sheet or contact Hilarie Ashton at hashton@vera.org.