2008 NC DAN Statewide Congress Registration

Name (Required)

E-mail (Required)

Street Address (Required)

City (Required)

State (Required)

Postal Code (Zip) (Required)

Phone / TTY (Required)

Accommodation Requests

Please put an “x” next to your accommodation needs while attending the Congress

Braille

Computer Disk (Text-Only CD)

Large Print

Materials on Audio CD

Reader or Note taker

Interpreter, please circle appropriate type of interpreter: [ASL, PSE, ORAL, Exact English]

Assistive Listening Device

Real-Time Captioning / CART

Personal Assistant

Other accommodations (Dietary, etc.)

If Other accommodations requested, please explain

Registration Fee (Required)

Registration Fee is $30 per person. Personal Assistants are not required to pay the registration fee. Fee includes all materials, workshops and coffee breaks. Limited financial assistance is available on a first come first serve basis.

I will pay my registration fee of $30 online (payment link will appear on "Thank You" page)

I will pay my registration fee of $30 by check (make checks payable to Disability Rights and Resources)

I request an application for financial assistance to attend the Congress

Other

I am interested in sharing a guest room at the hotel

I am interested in ride sharing with participants from my community

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