Self-Advocates Networking Night

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Join us for a night of networking with self-advocates from the intellectual and developmental disabilities community! Brought to you in part by the Self-Advocacy organizations across the state!

When: August 5, 2024 from 6 PM - 8 PM

Where: Grand Sierra Resort Bowling Center 2500 2nd St, Reno, NV 89595

Registration is not required but is highly recommended!

Events will include bowling, networking, a magic show, resources, and heavy hors d'oeuvres!

Name (as it appears on your driver's license): *

Email Address. If you don't have one enter N/A *

Phone Number: *

Address: (FULL ADDRESS IS NEEDED, this means the Numbers, Street, Apartment # (if applicable), City, State, and ZIP.) *

For example: 123 Main St. Apt. 23, Carson City, NV, 89706

Organization, agency or self advocacy group representing. If not applicable enter N/A *

I am attending as: *

Individual with a Developmental or Intellectual Disability (I/DD)

Family Member of a Person with a Developmental or Intellectual Disability (I/DD)

Professional that works in the Developmental or Intellectual Disability (I/DD) Community

Support Staff or Personal Care Attendant providing support to another conference attendee ONLY.

Other:

I am: *

White

Native Hawaiian or other Pacific Islander

Asian

Black or African American

Native American/American Indian

Hispanic/Latino

Two or more races

Middle Eastern or North African

I don’t know my race/I choose not to tell you what my race is.

Do you think of yourself as: (Please note we are required to ask this question. You are not required to answer.) *

Male

Female

Transgender Male

Transgender Female

Genderqueer/gender nonconforming neither exclusively male nor female

Other

Decline to Answer

What sex was originally assigned on your birth certificate? (Please note we are required to ask this question. You are not required to answer.) *

Female

Male

Prefer not to say

Decline to Answer

Other:

Do you think of yourself as: (Please note we are required to ask this question. You are not required to answer.)
*

Straight or heterosexual

Lesbian or gay

Bisexual

Queer, pansexual, and/or questioning

I don't know

Prefer not to say

Decline to answer

Other:

I (we) will need: (If your organization has funds to pay for your travel, you MUST use those funds.) *

Mileage or Parking Reimbursement

PCA Fee or Respite Care Reimbursement

Respite Reimbursement

Other:

Required

Accommodations Requested *

American Sign Language Interpreting Services

Spanish Translation Services

Translation into any language other than Spanish or American Sign Language

Accommodations for Town Hall Materials (I.e. Large Print)(Please specify in other)

CART Services

None

Other:

Required

Do you have any medical conditions we should be aware of (health, allergies including food)? *

Do you have any other needs we can attempt to accommodate for? (Please note we will make every effort to make reasonable accommodations for all guests.)

What are your major concerns (if any) about the disability community in Nevada? *

Submit

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