*1.Which BikePGH event or workshop are you planning to attend? Please provide the name and date.(Required.)

*2.Select any accommodations you may need. We will work with local, trained professionals to provide the services requested to the best of our ability.(Required.)

ASL interpretation

Advance copy of slides to be projected

Assistive listening device

Captioning

Childcare

Gender-neutral bathroom

Lactation room

Large print

Low-sensory room (quiet, reduced lighting)

Reserved front row seat

Scent-free room

Translation services

None of the above

*3.If requesting childcare on-site during the event, what is the age of the child/children you would bring with you?(Required.)

1-3 years

4-6 years

7-17 years

I don't plan to bring any children with me

If childcare was provided, how many children in each range would accompany you?
(Example: one five year, one eight year old, and two sixteen year olds.)

4.If requesting translation services, what is your native language?

5.Do you have any allergies or dietary restrictions?

Vegetarian

Vegan

Gluten Free

Peanut Allergy

Tree Nut Allergy

Soy Allergy

Milk Allergy

Other (please specify)

6.We strive to remove barriers and, as such, want to make sure you can participate as fully as you'd like. What can we do to ensure that's possible that hasn't been addressed above?

*7.We'd like to follow up with you regarding any accommodations requested, please provide your name and email address.(Required.)