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Disability Community Seminar Registration Form

National Clearinghouse on Disability and Exchange www.miusa.org/ncde

Disability Community Seminar

Accessing the World through International Exchange

 

The Accessing the World through International Exchange seminar will take place on Tuesday, July 13, 2010 from 1:00 p.m. - 5:30 p.m. at the Sheraton Denver Downtown Hotel -- 1550 Court Place in Denver, Colorado 80202.  **Registration for this event is now closed**

This seminar is for citizens and residents of the United States. To sign up to participate, please fill out the following form by June 25, 2010. There is a limit of 50 seminar participants. We encourage representatives from disability organizations to attend. We use your contact information only for purposes of communicating with you for this seminar; we do not share or sell contact information with others. 

If you cannot access the form or cannot wait for it to submit (may take up to 1 minute), you can download the Rich Text version to fill out and email or fax in by clicking here. If you still cannot access the form, please contact us at clearinghouse@miusa.org or 541-343-1284 (tel/tty).

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Please enter your first name in the blank field. Then hit Tab to get to the next last name field. JAWS users should keep the forms mode on throughout the entire form.
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Please enter your last name in the blank field.
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Please indicate if it is a voice, video or text phone.
Fill in the name of your workplace, organization, school, etc. if applicable.
This is so we can send you information related to this seminar. To enter your information, use the Tab button to advance from the address field to the city, state, and zip code blank fields that follow.
Fill in if you are attending as an individual with a disability who is interested in going abroad, and/or if you work with people with disabilities to whom you intend to bring back information about overseas opportunities. Mark all that apply by clicking in the checkbox next to each item, or by using the Tab key to move to between options and pressing the Spacebar to place a check in the box. This information will assist us in balancing the types of seminar participants.
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Please provide details here if you marked "Other" above.
Indicate if you will need any disability-related services to participate fully in this seminar and the formats of materials you prefer for the day's agenda and schedule and for take home materials. Mark all that apply by clicking in the checkbox next to each item, or by using the Tab key to move between options and pressing the Spacebar to place a check in the box. We will contact you for further details. Note: We are no longer able to provide CART services at the seminar. ASL interpreters will be available.
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All participants will receive a CD-ROM data disc of the day’s agenda and seminar materials, as well as take-home materials and resources. CDs will contain these materials in electronic rich text and Doc/PDF formats. Please select a format for the materials you will receive in hard copy to use during the day of the seminar.




If you marked "Other" above or need to provide more details on your accommodations request, please provide specifics here.
If you will be bringing along an assistant, please enter their name in the blank field so they are included in our event lists. If you will be bringing someone but do not yet know their name just indicate in the field "to be decided." Then hit Tab to get to the next field.
Please indicate if you have dietary restrictions or preferences for the catered lunch. Select all that apply by clicking in the checkbox next to each item, or by using the Tab key to move to between options and pressing the Spacebar to place a check in the box. Disability-related assistants that accompany a registered attendee will also be provided a meal.
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Please indicate if you have other dietary requests related to food restrictions.
(Optional) This information on your interests will help us to best tailor the seminar for participants. Mark all that apply by clicking in the checkbox next to each item, or by using the Tab key to move to between options and pressing the Spacebar to place a check in the box.
(Optional) This information on your interests will help us to best tailor the seminar for participants by knowing your age or the age of those who you will be sharing this international exchange information with. Mark all that apply by clicking in the checkbox next to each item, or by using the Tab key to move to between options and pressing the Spacebar to place a check in the box.
(Optional) Fill in your disability type. Mark all that apply by clicking in the check box next to each item, or by using the Tab key to move to between options and pressing the Space bar to place a check in the box. This information will assist us in tailoring the seminar to participants.
Please provide details here if you marked "Other Disability" above.
If you are attending on behalf of other people, please fill in the disability type or types of those with whom you are associated. If several apply, mark "cross-disability."
Please provide details here if you marked "Other Disability" above.
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Please indicate how you will submit the $40 registration fee. Further information on how to do this is given directly below the submit button and also after you have submitted your form. Mark your payment type by clicking in the checkbox next to each item, or by using the Tab key to move to between options and pressing the Spacebar to place a check in the box.
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Please be patient when submitting as it can take up to one minute to process. If you do not receive a thank you page to show it has gone through, we may still receive your completed form. You can call 541-343-1284 tel/tty to verify or wait 1-3 days to see if you receive a thank you for registering email from us. You can also print the above form and mail (see address below) or fax it to us at 541-343-6812. Another option is to download a Rich Text version and email it to us as an attachment.

Final Step to Register

To complete your registration, you will need to pay the $40 registration fee (to request a reduced registration rate for financial reasons, please fill out the registration form and then email reasons you would qualify for a reduced rate to abryant@miusa.org).

 You may pay your $40 application fee by using one of the following methods (this information is also available on the web page after you click and submit your registration form):   

  • Paypal

After submitting your registration form, you can pay with a credit card online by clicking on this PayPal link.

  • Check or Money Order

Make the check payable to Mobility International USA (see below).

  • Telephone or TTY

Call (541) 343-1284 and provide your credit card information to MIUSA directly.

 

To pay by check, make it out to "Mobility International USA" and mail to:

National Clearinghouse on Disability and Exchange

Mobility International USA

132 E. Broadway, Suite 343

Eugene, Oregon 97401 USA 


The NCDE would like to thank the U.S. Department of State, the Association on Higher Education and Disability (AHEAD) and other co-sponsors for making this seminar possible.


Go back to the main Disability Community Seminar page.

 

 
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