Arizona Statewide Independent Living Council

Arizona Legislative Information System (ALIS) Workshop Registration Form Click here to download a printable version, or Please complete the following information and submit
Registrant's Name:
Street Address:
City:
Zip:
Telephone:
Email:
Do you need an accessible accommodation?:
If yes, Please describe (e.g. Braille, Sign Language Interpreter): 200 character maximum
As part of the of the workshop agenda we will travel to the state capitol. Do you need wheelchair transportation for that trip?:
AZDAC has limited funding to reimburse individuals, who live outside the Phoenix metropolitan area, for travel and lodging. Do you need travel reimbursement?:
Would you like to receive AZ Disability Advocacy Coalition (AZDAC) alerts and information?:
Registration closes on April 24th