Registration

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State *

Zip Code *

County *

Phone *

Email Address *

Attending Options *

Fair ParticipantWalk-N-Roll ParticipantVolunteerCheck mark all those that apply. PLEASE NOTE: As part of the IowAbility Fair, the Walk-N-Roll fundraiser is free to attend. If you’d like to help raise money for the Spina Bifida Association of Iowa or Iowa Chapter of United Spinal Association, please visit the Walk-N-Roll page on this website for more information and links to each organization’s “Pledge It” page to sign up.

FAIR PARTICIPATION

Please tell us more about you (so we can plan for participation accordingly) *

I have spina bifidaI have a spinal cord injuryI have other mobility-related disabilityI am a family member of a person with a mobility-related disabilityI am a caregiver

How many people will be attending with you, not counting yourself? Please list all names and ages (if 18 or younger). *Please separate number and names with commas

Physical therapy students will assist in transfers for the various activities provided at IowAbility Fair. Volunteers will also provide assistance with meals if needed. Do you have any other specific accommodation needs other than those that will be provided? PLEASE NOTE: You must provide your own caregiver if needed.

VOLUNTEERING

Are you a PT/OT student volunteer? *YesNo

Please choose the shift you'd like to work *

11 AM – 1 PM1 PM – 3 PMYou may check both if you'd like

Volunteer Shifts *

Saturday (set up only) | 4–7 PMSunday | 9 AM–12 PMSunday | 12–3 PMSunday (tear down & clean up) | 3–6 PMCheck mark all shifts you are available and we will reach out to you with options regarding where we have the most need.

Volunteering Abilities *

Able to lift 20 lbs. or moreAble to carry/transfer 20 lbs. or moreAble to lift less than 20 lbs.Able to carry/transfer less than 20 lbs.Able to stand for long periods of timeAble to sit for long periods of timeTo help us determine what tasks to assign volunteers, please check all the abilities you have to provide.

If volunteering as part of an organization, school, etc, please provide its name

Are you 17 or younger? *YesNo

Volunteers 17 and younger need to be paired with an adult. If you know of an adult volunteer that will be at the event that you'd like to work with, please provide their first and last name below.

Please share anything special we need to know about you and/or any specific requests you may have for us.

MEALS

Will you and/or your group eat lunch on Sunday? *YesNo

How many regular meals will be needed? *

How many gluten-free or vegan meals are needed?

LODGING

Would you like to stay overnight at Easterseals the day before IowAbility Fair (Saturday, October 5)? *YesNoAccessible, community-dorm-style accommodations are available for FREE. You can stay on the Easterseals campus the night of October 5. A free, optional meal will be provided that evening and a continental breakfast in the morning. Bedding provided, but must bring own towels and toiletries. PLEASE NOTE, you must provide your own caregiver, if needed.

How many adults (18 or older) will be staying overnight with you October 5?

How many children (17 or younger) will be staying overnight with you October 5?

Participants & Volunteers