U.S. DEPARTMENT OF EDUCATION
"THE AMERICANS WITH DISABILITIES ACT:
CELEBRATING THE PAST, PLANNING FOR THE FUTURE” ~ RSVP FORM

Lyndon Banes Johnson Building
400 Maryland Avenue, SW
Washington, DC 20202

July 24, 2015 9:00 am- 12:00 noon

*mandatory questions

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* 1. First name of the participant

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* 2. Last name of the participant

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* 3. Organization Name (if any)

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* 4. Email Address

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* 5. Best phone number to contact

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* 6. How did you learn about this event? (check all that apply)

Educational institution

Email

Disability organization

Social media

Friend/ colleague

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* 7. Which part(s) of the event do you plan to attend? (check all that apply)

Panel Discussions (9:00 am-10:20 am)

Outdoor Ceremony (10:30 am-11:00 am)

Outdoor Activities (10:00am to 10:30am and 11:00am to 12 noon )

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* 8. Emergency Contact Information (Please complete this section if participating in outdoor athletic activities)

Name

Relationship to Participant

Phone Number 1

Phone Number 2

Email Address

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* 9. If you require a reasonable accommodation to participate in this OCR event (e.g., sign-language interpreter, captioning services, Braille, large print, or CD-ROM), please indicate below and submit by Friday, July 17th (5 business days prior to the event).

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* 10. Is anyone accompanying you to this event?

Yes

No

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* 11. If yes, please specify their name(s) and relationship(s).

Name

Relationship

Name

Relationship

Name

Relationship

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* 12. Would you like to join forces with us to spread the word about this event? (If yes, you will be entitled to receive exclusive communications from the U.S. Department of Education as we partner with you to make this the best event ever!)

Yes!

Not at this time.