Disability Education and Etiquette Registration

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
The following information is kept confidential and is requested only for the purpose of insuring that the class sessions are diverse.
Age:*
Gender:*
- Male
- Female
Indicate why you are interested in enrolling in CACS’s Disability Education and Etiquette program:
What do you hope to gain or learn from participating in the Disability Education and Etiquette program?
Describe your involvement with the disability community and/or other community/civic activities:
How did you hear about CACS’s Disability Education and Etiquette program?
Please share any accommodations you require.
- Braille Materials
- Large Print
- Taped Session
- Wheelchair Accessibility
- Note Taker
- Sign Language Interpreter
Additional Comments:
Cost of Registration*
Price: $25.00