Registration form for the Global Disability Summit Argentina 2019

Last name *

Name (s *

Age *

ID number / ID / Passport *

Landline / work telephone number

Cell phone number *

Email *

City / Town

Province

Country *

Profession *

Workplace *

Government.

Non-Governmental Organization.

Are you a member of an Organization of People with Disabilities and their Families?

Others

Position *

Are you a person with a disability? *

Do you require some kind of support or reasonable adjustment? *

Do you use braille

Yes

Do you require personal assistance *

If your answer is Yes, complete below what Type of assistance.

Yes

What kind of human assistance do you need?

Companion

Sign Language Interpreter

Personal assistant

Guide Interpreter

How will you reach Tecnópolis? *

With my own car.

Public transportation / by your own means.

Free transfer service.

To use the free transfer service, you must present the confirmation of accreditation at any of the free transfer points.

Free shuttle service

Constitution. Lima 1400. Frequency to be confirmed.

Eleven. Avenida Rivadavia 3085. Frequency to be confirmed.

Center. Avenida Santa Fe y Cerrito sobre Avenida Santa Fe 1115. Frequency to be confirmed.

Italy Square. Avenida Sarmiento 2725. Frequency to be confirmed.

If you selected the free transfer service, indicate one of the following options

Activities in which you will participate *

Civil Society Forum. June 6, 2019

activities. June 6, 2019

Global Disability Summit. June 7, 2019

activities. June 7, 2019

Symposium. June 7, 2019

Do you require a certificate of attendance to the Global Disability Summit *

It will be sent to the declared email once the Summit is over and after checking attendance on Thursday and Friday (Excluded).

Yes

No.

Observations

Presidencia de la Nación

Registration form for the Global Disability Summit Argentina 2019