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RSC Consumer Advisory Committee Meeting RSVP

 

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1. First Name

First Name

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2. Last Name

Last Name

3. Address

Address

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4. City

City

5. State

State

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6. Zip Code

Zip Code

7. Email Address

Email Address

8. Phone number

Phone number

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9. Are you an RSC consumer?

Are you an RSC consumer?   Yes No Family Member is Consumer Friend is Consumer

10. Are you a service provider?

Are you a service provider?   Yes No

11. Organization Affiliation (if any)

Organization Affiliation (if any)

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12. Meeting Site You Will Attend

Meeting Site You Will Attend   Toledo - September 13 at The Ability Center of Greater Toledo, 5606 Monroe St., Sylvania Cincinnati - September 15 at Butler Co. RSC Office, 8050 Beckett Center Dr., Ste. 216, West Chester Dayton - September 16 at Wright State University, Student Union, Room E-156, 3640 Colonel Glenn Hwy., Fairborn Columbus - September 20 at RSC Central Office, 3rd Floor Conference Rooms 6&7, 150 E Campus View Blvd., Columbus Akron - September 21 at Goodwill Industries of Akron, 570 E Waterloo Rd., Akron Cleveland - September 22 at Cleveland Sight Center, 1909 E 101st St., Cleveland Youngstown - September 23 at the Butler Institute of American Art, Butler North Education Center, 524 Wick Ave., Youngstown Marietta - September 29 at Washington State Community College, Main Building Community Room, 710 Colegate Dr., Marietta

13. Do you need any special accommodations?
(Please let us know if you have a hearing impairment so that we can have a sufficient number of interpreters for small group discussion.)

Do you need any special accommodations? (Please let us know if you have a hearing impairment so that we can have a sufficient number of interpreters for small group discussion.)

14. Will you bring a guest?

Will you bring a guest?

15. If bringing a guest/guests, please indicate how many?

If bringing a guest/guests, please indicate how many?

16. How did you hear about the RSC Consumer Advisory Committee meeting?

How did you hear about the RSC Consumer Advisory Committee meeting?   I am a CAC Member From a VR Counselor From a Friend Saw it Online Received an Email Saw a Poster Other

Other (please specify)

17. Would you be interested in learning more about the RSC Consumer Advisory Committee?

Would you be interested in learning more about the RSC Consumer Advisory Committee?   Yes No, thanks.