Westercon 48 Handicap Access Questionnaire


If you will need any assistance at Westercon, please print out this
form, fill it out, and mail it to:

	Westercon 48 Handicap Access
	PO Box 2584
	Portland, Oregon 97208-2584 

My Name ___________________________________________________________

Membership # ______________________________________________________

Address ___________________________________________________________

City, State, ZIP __________________________________________________


Helper's Name _____________________________________________________

Membership # ______________________________________________________

Address ___________________________________________________________

City, State, ZIP __________________________________________________

Handicap Access PUBLICATIONS I will need:

    [] Large-print publications: [] Program Book  [] Pocket Program
    [] Cassette "talking book":  [] Program Book  [] Pocket Program
    [] Other: _____________________________________________________


ASSISTANCE/EQUIPMENT I will need: 

    [] Occasional help
    [] Standard wheelchair (for a  [] Short time or  [] Whole con)
    [] Wheelchair pusher   (for a  [] Short time or  [] Whole con)
    [] Other: _____________________________________________________


Handicap Access SEATING/ASSISTANCE I will want: 

    [] ASL Sign Interpreter  [] Hearing Loop  [] Footstool
    [] Vision-impaired       [] Wheelchair/Scooter

    for: 

    [] Myself  [] My helper  [] My family: _____ persons

    at: 

    [] Opening Ceremonies    [] GoH Speeches  [] Masquerade
    [] Closing Ceremonies    [] Other: ____________________________


Other:

    [] I will also need help with: ________________________________
    [] I will be accompanied by a Service Dog.
    [] I will be accompanied by an Attendant.
    [] I'm a recent convert (fell, hit by car, etc.) and need all 
       the tips you can give me!


This questionnaire is based on a standard questionnaire provided by Electrical Eggs.
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