test – IowAbility Fair

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? 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. Do you have any 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 *

10:30 AM – 1:30 PM1:00 PM – 4:30 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.

Are you able to complete physical tasks (ie. carrying items)? *YesNo

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

Name(s) of other volunteer(s) you hope to work withPlease use a comma to separate names

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

MEALS

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

How many meals will be needed?

How many need to be gluten-free or vegan?

LODGING

Would you like to stay overnight at Easterseals the day before IowAbility Fair (Saturday, October 5)? *YesNoAccessible, dorm-style accommodations are available for FREE. You can stay on the Easterseals campus the night of September 29. A free meal will be provided that evening and a continental breakfast in the morning. PLEASE NOTE, you must provide your own caregiver, if needed.

How many adults (18 or older) will be staying overnight with you September 29?

How many children (17 or younger) will be staying overnight with you September 29?