RespectABILITY Conference October 22, 2010 Registration and Scholarship Form

Deadline to Register: October 10, 2010

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Registration Form
















RespectABILITY Self-Advocacy Workshops
(Please select the Workshop(s) You Wish to Attend):
Benefits Workshop
Employment Rights Workshop
Housing Rights Workshop
Legislative Advocacy Workshop

ACCOMMODATIONS:
(Please select the Accommodation(s) You Will to Attend):
All requests for accommodations must be received by 9/30/2010.
Sign Language Interpreter
Large Print Materials
Language Interpreter, specify language
Braille Materials
Assistive Listening Device
CD Rom Materials
Real Time Captioning
Other:    Please Specify:

HOTEL INFORMATION
Will you need accessible parking
Will you need accessible room
Other hotel needs

Payment Method:
Registration Fees:
$35 Paid by 9/27/10
$40 Paid After 9/27/10

Registration Fee includes conference, materials, breakfast, lunch and parking.
Scholarship Requested - click button for application.
Check Enclosed Payable to D.R.L.C.
MasterCard or Visa only (We cannot accept any other credit card)
I'm a panelist

Enter Credit Card Details









  USA




Scholarship Appplication Form RespectABILITY 2010 is offering a limited number of full and partial conference
scholarships to persons with or without a disability living in California, who want
to attend the Conference, but cannot afford the costs. To apply for a scholarship, please answer ALL questions and forward this application with your registration form to D.R.L.C. no later than September 30, 2010.

Please select which scholarship you are applying for:
Conference Registration Scholarship ? includes conference fees, refreshments, parking
Travel Scholarship ? transportation to/from Burbank Marriott for participants residing over 60 miles from Burbank, or with special circumstances
Hotel Accommodations, Thursday night, October 21 ? for participants residing over 60 miles from Burbank, or with special circumstances

Other: Please Specify:

Question 1: Why do you want to attend the RespectABILITY Conference?



Question 2: What do you hope to gain from attending the RespectABILITY Conference?



Question 3: How do you plan on using the information you learn at RespectABILITY 2010?



Please select reason for applying for a scholarship:
My monthly income prevents me from paying for conference registration
My organization or employer will not pay for me to attend the conference
Name of My Employer.
Please Specify:


Other hardships which make a scholarship necessary.
Please Specify:












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To Register ?
Forward completed
registration and scholarship
forms to:

On Line: www.RespectabilityCoalition.org

Mail
RespectABILITY 2010
c/o DRLC
919 South Albany Street
Los Angeles, CA 90015

FAX
(213) 736-1030

Email: Sasha.Yu@lls.edu

For Questions or Alternate Format:
Call: Sasha Yu
213-252-7438
 
 
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