Registration for Training in Emergency Preparation for People with Disabilities
Friday, March 31st, 2017
9:30 a.m. to 4 p.m.
at the Agency on Aging of South Central CT
1 Long Wharf Dr Ste 1L, New Haven, CT 06511

Greetings!

Prep is Personal: Find the Fridge!

A Workshop on Emergency Preparation for People with Access and Functional Needs, including Disabilities

This workshop is funded by the CT Council on Developmental Disabilities and co-sponsored by the UConn Center for Excellence in Developmental Disabilities, the City of New Haven Department of Services for Persons with Disabilities, and the CT State Independent Living Council.

The topic is emergency preparation for people with disabilities. People with disabilities, their families and/or support staff, First Responders, and others involved in community emergency management are encourage to attend.

Space is limited. Board, staff, partners, and invited guests of the City of New Haven Department of Services for Persons with Disabilities will be given first priority for admission. All others will be enrolled on a first-come, first-served basis.

NOTE: Anyone requiring accommodations (e.g., sign language interpreter, environments free of specific allergens) must contact Daria Smith (860-679-1522 or daria@ctsilc.org) no later than 3 p.m. on Monday, March 20, 2017

If you have any other questions or concerns, please contact Linda Rammler at lrammler@uchc.edu (email preferred) or leave a message at 860-679-1585

Question Title

* 1. How would you describe your primary role?

Self-Advocate/Person with a Disability

Family Member/Caregiver

Professional

Other (please specify)

Question Title

* 2. Please provide us with the following information (please enter "N/A" in boxes that do not apply)

First Name:

Last Name:

Agency:

Address:

City/Town:

State:

Zip Code:

RTI or TTY:

Home or Cell Phone Number:

Work Phone Number:

Email Address (email is the primary non-emergency form of communication for information about the training, please provide an email that you will check regularly):

Question Title

* 3. Do you need any special accommodations to participate? Please check all that apply.

Not Applicable

Personal Assistant Attending

Sign Language Interpreter Needed (closing date 3/20/17)

Accommodations (alternate format, Spanish translation, etc.- please specify)