April 28, 2009 − Eighth Annual Fair Housing Symposium
Yes We Can! Prevent Housing Discrimination
Hosted by the DC Office of Human Rights, Department of Housing and Community Development and the Equal Rights Center
True Reformer Building− 1200 U Street NW, Washington, DC
Registration: 8 am − 9 am
Program: 9 am − 4 pm
*Required fields must be completed to submit form. Please put “n/a” if field does not apply to you.
1. Individual Registration
Date:
First Name*
Last Name*
Title
Organization Name*
Organization Type
Select One
Private
Government
CBO
Other
Street Address
City
State
Select One
DC
Maryland
Virginia
Zip Code
Email Address*
Phone Number*
Fax Number
Ward
Select One
1
2
3
4
5
6
7
8
2. How did you learn about the symposium?
(1) Direct Mailing by:
OHR
DHCD
ERC
(2) Direct E−mail:
OHR
DHCD
ERC
(3) Community Based Organization (CBO)
(4) Media:
Radio
TV
Newspaper
Community publication
(5) Other:
3. Are you a:
Private Resident?
Yes
No
Advocate?
Yes
No
Government Employee?
Yes
No
Community Based Organization or
Community Development Corporation Staff?
Yes
No
Apartment/Condo/Coop Building Manager?
Yes
No
Building Engineer/Maintenance staff?
Yes
No
General Contractor/Architect?
Yes
No
Real Estate Developer?
Yes
No
Financial Services Provider?
Yes
No
Licensed Real Estate Professional?
Yes
No
4. What information would you like to receive from this training?
5. Will you require a reasonable accommodation?
Yes
No
If yes, please specify
Sign language Interpretation
Other
LARGE FONT MATERIAL
6. Do you require language interpretation?
Yes
No
If yes, please specify
Spanish
Vietnamese
Cantonese
Mandarin
Amharic
French
PLEASE NOTE
: Language interpretation service will be provided to Pre−Registered groups, of a
minimum, of 5 Limited English (LEP) individuals of the same language. Other efforts of interpretation
can be provided by bilingual staff on an as−need and availability basis for single individuals.
Pre−Registration ends on April 14, 2009.
Do you have any Dietary Restrictions?
Non−vegetarian meal
Vegetarian meal
Other
If other, please specify
Submit
Reset
Go
Print
80%
100%
120%