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2. The City of Roanoke is committed to providing access to all public facilities for people with disabilities. This form is for people with disabilities to request accommodation to attend city sponsored events. If you simply want to RSVP for an event, please do not use this form. If you need assistance in completing this form, please call the Office of Risk Management at 540-853-2450.
   
   Please note that the city does not provide wheelchairs, scooters, or other mobility devices. Guests and visitors with mobility impairments must bring their own mobility devices. Accessible parking spaces are available for vehicles with official disability plates or placards. Vehicles parked in accessible parking spaces without official disability plates or placards may be ticketed and or towed.
4. This request is for:

   1. Self

   1. Family Member

   1. Other
6. Explain Other
8. Name
9. Email Address
11. Address
12. Phone Number
14. Event Name
15. Location
17. Date
    Date
18. Type of Accommodation

    1. American Sign Language (ASL) interpreter
    2. Communication access real time
    3. Accessible reserved seating
    4. Materials in alternative format
    5. Dietary restrictions, if offered
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field