The meeting site has basic accessibility. Amplification will be used in large groups. Attendees are requested to refrain from using scented products. Persons requiring additional accommodations or alternative formats to participate should submit this form when registering.

In order to participate, I will need:

☐ Transportation to and from the event

☐ Accessible parking space

☐ Wheelchair seating and table access

☐ Chair with armrests or other seating considerations: __________

☐ Sign language (ASL) interpreter

☐ Assisted listening device: earbuds ☐ / neck loop ☐ / other ☐

☐ Note-taker ☐ / Reader ☐ / Audio describer ☐

☐ Captioning (e.g., CART – projected notes of what is said)

☐ Large-print handouts (font size needed: __________)

☐ Braille handouts

☐ Materials provided digitally prior to event by email

☐ Guide or orientation to facilities

☐ Accommodations for service dog

☐ No exposure to: peanuts ☐ / flashing lights ☐ / other:

☐ A quiet space for sensory breaks if needed

☐ Special diet:

☐ Assistance with meal:

☐ Other:

☐ An assistant will accompany me (needed for meal count)

☐ I am driving and could provide transportation for others

☐ I am able to assist with inclusion and accessibility in these ways:

Name: __________________________________________
Best contact method: ________________________________
Phone: __________________________________________
Texting OK: Yes ☐ No ☐
Email: ___________________________________________

Updated 2/17/24