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Participant Registration Form

By Barbara Palmer,2014-03-20 15:42
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Participant Registration Form

    Accessibility Showcase

    March 8 10, 2010

    Pan Pacific Hotel

    Vancouver, BC

    Participant Registration Form

INTRODUCTION

    On behalf of the Accessibility Showcase Organizing Team, we would like to thank you for your interest in the Showcase.

Registration to attend the Showcase is FREE, but space is limited and is based

    on a first-come, first-served basis. Participants are required to make arrangements and cover the costs for their hotel, travel and meals.

    To register for the Showcase, as well as to inform the Showcase Organizing Committee of any accommodation needs you may have while attending the Showcase, we are requesting that you complete this form and return it via email to ACCESSIBILITY-SHOWCASE-RSVP-GD@servicecanada.gc.ca

    If you have questions, or require assistance to register, please do not hesitate to contact Michelle Boutilier at 819-934-1193 or via email at michelle.boutilier@hrsdc-rhdcc.gc.ca

PARTICIPANT INFORMATION

Salutation (e.g.,

    Mr./Mrs./Ms.)

Name

Title

Organization

Name for badge

Accessibility Showcase Registration Form

    All personal information collected is protected under the Privacy Act.

HOTEL ROOM ACCOMMODATION

    It is the responsibility of Showcase attendees to make their own hotel reservations. For those attendees requiring hotel accommodation, the Showcase Organizing Team has set aside a block of rooms at the Pan Pacific at a rate of $149 per night.

    Rooms in this room block are available on a first-come, first-served basis, and can ONLY be held until February 15, 2010, so please make your reservations as

    soon as possible. After February 15, 2010, attendees requiring hotel

    accommodation may be subject to a higher room rate.

    604-662-3223 To reserve your hotel room, contact the Pan Pacific hotel directly at or toll-free at 1-800-663-1515. When speaking to the reservation agent be sure to use the reservation ID: HUMANRES in order to obtain the reserved room rate of $149 per night.

TRANSPORTATION TO OPTIONAL EVENING ACTIVITIES

    Optional evening activities have been organized for those Showcase participants who wish to attend. These include a visit to the Out from Under Exhibit (Monday evening) and a tour of the Vancouver’s Blusson Spinal Cord Centre (Tuesday evening).

    For those Showcase attendees who are planning to attend the optional evening activities, the Showcase Organizing Committee is making arrangements for a number of accessible taxis to be available to those who require accessible transportation to and from the event. Please note, however, that the costs associated with transportation to these optional evening events are the responsibility of the Showcase participants.

ACCOMMODATION AND INCLUSION REQUIREMENTS

    To ensure that we meet your accommodation and inclusion needs while attending the Showcase, we are requesting that you complete the following:

Do you have any dietary needs? ; No

    ; Yes ___________________(please specify)

Do you have any specific mobility ; No

    requirements?

    ; Yes ___________________(please specify)

    ; No Do you require assistance in the event of

Accessibility Showcase Registration Form

All personal information collected is protected under the Privacy Act.

an emergency evacuation?

    ; Yes ___________________(please specify)

    Do you have any specific requirements ; No for overnight accommodations, including equipment needs that the hotel must ; Yes ___________________(please specify) provide?

What is your language preference? ; English

    ; French

     ; No

    Will you require simultaneous translation

    ; Yes (English to French / French to English)?

    ; No

    Do you require interpretive services? ; American Sign Language (ASL)

     ; Assistive listening system

     ; Real time captioning

    ; Other: __________________ (please specify)

    ; No

    ; Large Print

    ; Braille Do you require documents in alternate formats? ; Audiocassette

     ; Audio CD

    ; E-Text Diskette

    ; E-Text CD

    ; DAISY

     ; No

    Will you be travelling with a personal

    ; Personal Attendant attendant or guide dog?

    ; Guide Dog

For the optional evening activities will you ; No

    require accessible transportation (i.e.,

    ; Yes accessible taxis) to and from the event?

    Accessibility Showcase Registration Form

    All personal information collected is protected under the Privacy Act.

    If you will be accompanied by a personal Name: __________________________________ attendant please provide contact

    information and be sure to register the Phone Number:

    attendant for the Showcase. ___________________________

     E-mail address:

     ___________________________

     Is there anything else for which you may ___________________________________________ need assistance at the Showcase? ___________________________________________

    Accessibility Showcase Registration Form

All personal information collected is protected under the Privacy Act.

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