Name
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Organization
(if applicable)
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Street
Address
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City
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State
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Zip
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Phone/TTY
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Fax
|
|
Email
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Type
of Assignment
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|
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Description
of Assignment
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|
Date
of Assignment
|
|
Starting
Time
|
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Ending
Time
|
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Today’s
Date
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Location
of Assignment (address, directions, parking instructions, closest Metro stop)
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Event
Facilitator or Presenter
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|
Name(s)
of Deaf Customer(s)
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|
Language
Preference
|
|
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Preferred
Interpreter (if applicable)
|
|
Primary
On-site Contact
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Cell
Phone/Pager
|
|
Back-up
Contact (manager, receptionist, event planner,
building security guard)
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|
Back-up
Phone/Pager
|
|
Additional
Comments
|
|
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Contact PINS (202)638-5630 information@pinsdc.com
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