Disability History Exhibit Request Form

Name

First Name

Last Name

Institution Name

Phone

(###)

###

####

Date Requested

When do you need the disability exhibit to arrive at your institution?

YYYY

How many days will you need the disability exhibit at your institution?

Proposed Return Date

When will you no longer need the disability history exhibit at your institution?

YYYY

Purpose

Please let us know how you plan to use the Disability History Exhibit

Thank you for submitting a proposal to present at ORAHEAD’s Fall 2020 Conference! If your proposal is selected, we will be in touch with confirmation of dates and how to submit your presentation materials. Proposals not selected for this year’s conference may be considered for future conferences.