Accessibility Registration Form

The Independence Center is committed to being access-centered so that everyone can participate in our events. Please complete this survey to let us know the accommodations you need to participate fully in this event.

In order to successfully accommodate your request, we ask that you make requests at least one (1) week prior to the event. Thank you!

4. Please check any accommodation(s) you need to participate in this event.(Required)
Other accommodations:
5. Please let us know what your pronouns are.