PAS Priority Backup Study Forum Registration

The Personal Assistance Services (PAS) Priority Backup Study Forums are FREE to attend, however, space is limited so register early! Please complete ALL the following sections of the following registration form. Please contact the following persons for more information on driving directions, information on public transportation and Paratransit services.
TRCIL Cindy Williams 900 Rebecca Ave. Pittsburgh, PA 15221 Phone: (412) 371-7700 TTY: (412) 371-6230 Tollfree: (800) 633-4588	ARCIL Sheila Albertson 44 W. Broad Street Hazelton, PA 18201 Phone: (570) 455-9800 TTY: (570) 455-1731 Tollfree: (800) 777-9906

Denotes a Required Field

Registration Information

Name:

Address:

City:

State: Zip:

Home Phone:
(777) 732-2000 format

Email:

PAS Backup Forum Location (please only choose ONE location)

Pittsburgh- TRCIL - September 5

Schuylkill - Schuylkill Mall Sears Wing- More Mobility Showroom - September 11

Please check ALL Alternate Format requirements:

Braille

Tape

Disk

Large Print

Please check if your require Personal Assistance Services:

No

Yes

Additional Information

Additional Comments or Other Accomodations: Comments or Other Accomodations

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