REGIONAL TRAINING SESSION ON TELECOMMUNICATIONS POLICY
FRIDAY, JUNE 25, 1993, 9:30 a.m. - 5:30 p.m.
SHERATON HOTEL, 39 DALTON ST.,  BOSTON, MA

                              
REGISTRATION FORM

This registration form must be received by Thursday, June
17th.  If it is possible to let us know of accommodation
needs earlier, please do so.  Please mail this registration
form to:  Mass. Coalition of Citizens with Disabilities, 80
Boylston Street, Suite 339, Boston, MA, 02116, or fax it to
617-482-2248.  If you have any questions or need assistance
in completing this form please call Anne Marie at 617-482-
1336 (Voice and TDD).  This form is also available in large
print or braille upon request.

Name:                                                       

Address:                                                    

Phone:  Home               Work                             

If you work for a disability-related organization, please
list it, with an address and phone.



If you belong to a disability-related organization, please
indicate which one(s).



Are there specific telecommunications applications or issues
that you are interested in?



Do you have any accommodation needs related to participating
in the conference?
(Please be sure to include your phone numbers above if you
list any accommodation needs.)

Sign language interpreters:         ___ASL           ___Oral 
         ___SE           ___Deaf-Blind

CART reporting (Computer-Aided Real Time reporting)         

Assistive listening devices  (specify type)                 

Materials in alternative formats:___Braille  ___Tape   ___Large Print   
                     ___ Computer Disks (specify type):     

Personal assistance ("floaters")                            

Dietary needs:                                              

Quiet room                                                  

Do you need information on accessible transportation?       

Other accommodations: