1. Attendee Information

Name

Title

Organization

Address

City State Zip

Phone (Voice) Phone (TTY)

E-mail

I am attending as part of a Team. Team member name(s)

I have been working in the the field of cultural arts access for:

Less than 3 years
3 - 5 years
5 - 10 years
10 - 15 years
More than 15 years

2. Accommodations
The conference site and all activities are wheelchair accessible.

Please indicate which of the following you will need to participate in the conference (check all that apply):

Sign Language Interpretor
Computer Assisted Real-time Translation
Printed materials in large print
Assistive Listening Device
Printed materials in Braille
Audio Description
Other ( Please specify)
I have special dietary requirements (please specify):

3. Organization Profile (Please check all that apply)

Non-profit
For-profit
Theatre
Government Agency
College or University
Service Agency
Arts Center
Museum
Other

4. Registration Information

Full Conference________________________________August 22-24

Please select one of the following.Prices listed are per person.

Arts or Cultural Organization Staff or Board Member
......................................................................Individual: $150/Team: $130
Arts or Cultural Service Agency Staff or Board Member
......................................................................Individual: $150/Team: $130
University or College Staff
......................................................................Individual: $150/Team: $130
State or Local Government Employee
......................................................................Individual: $150/Team: $130
Non-profit Disability Service Organization Staff
.........................................................................................................$250
For-profit Business or Consultant, Architecture, or Law Firm Employee
.........................................................................................................$450