Access Request Form

This access request form is to be completed by a conference or event delegate / attendee who requires accommodation at a CUPE Ontario Event.

Please only complete this form if you are the event attendee, and you are requesting accommodation.

This form must be submitted at least 30 days prior to the start of the event.

Note: You must complete this form if you require ASL Interpretation or French language interpretation.

Your Name *

Conference / Event name *

Local Number *

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Your Email Address *

Preferred Phone *

Alternate Phone

Preferred Language *Please select...EnglishFrançais

Event Accommodation Requests

Do you require ASL at the event?YesNo

Are you a French speaker who requires interpretation into French at the event?YesNo

Your Event Accommodation Requests:

Dietary Restrictions/AllergiesAccessible SeatingOffice chairScooter rentalSign Language InterpretationFrench TranslationAlternative Media - USB for large font electronicallyAdvance Material - ElectronicallyOther

Specific details about the accommodation

Hotel Room Accommodations

Your Hotel Room Accommodation Requests:

Physically Accessible Room (including a roll in shower)Visually Accessible Room for D/deaf & HoH guestsUnscented product use

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