Ohio River Border Initiative

Physical Accommodation Request Form

Please make sure that ORBI receives this request form at least two weeks before the date of the event specified below so that we can be sure to accommodate your request.

Name of person attending event:

Phone number of person attending event:

Request must include a phone number so that ORBI can confirm this request.

Please specify the ORBI event for which you are requesting accommodation:

Please specify the date of this event:

Please check below any accommodations that you may require:

Wheelchair accessible seating

Wheelchair accessible room

Wheelchair accessible transportation

Accessible parking

Print materials provided in large type

Print materials provided in braille

Print materials provided on cassette tape

Assistive listening system

Sign language interpretation

Oral interpretation

Personal assistance

Dietary - please specify

Other - please specify

Print & mail to: ORBI, P.O. Box 3, Chloe, WV 25235