UNISON Scotland Disabled Members Publications

Scottish Disabled Members Committee
Please print this form out to use. An online version will follow soon.

FACILITIES FOR DISABLED MEMBERS REQUEST FORM

DELEGATE DETAILS

PERSONAL ASSISTANT'S DETAILS

Name:....................................................

Address:.................................................

..............................................................

.............................................................

Tel No:..............................................

Voice Text.........................................

Name:...............................................

Address:............................................

..........................................................

.........................................................

Tel No:..............................................

Voice Text.........................................

Space for Guide/ Hearing Dog		Audio tape
Large Print		Braille
Large Print on disc		Specify Software: ................................
Disc		Specify Software: ................................
E-mail option		E-mail address: ......................................
British Sign Language		Sign Supported English
Lipspeaker		Speech to text
Induction Loop		Parking Space
Wheelchair Space		Wheelchair Access
Space for Personal Assistant
Do you require any other facilities? (Please provide details) eg help carrying bags at venue etc....................................... .............................................................................................................................. NB To be used by all Standing Committees of UNISONScotland - April 1999