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