Request Indiana Disability Rights Info Booth at Your Event

Please note: IDR requires you to submit a completed request form at least 4 weeks prior to your event to consider your request.

* Denotes Required Fields

* Contact Name:

* Day time phone number: -- ext.

* Contact email address:

* Organization Name:

* Organization Website URL:

* Event Name:

* Event Date:

* Event Start Time:

* Event End Time:

* Event Location:
       Venue/Building Name
       Street Address:
       City:
       State:
        Zip:

* Event Purpose:


Target Audience for Event: (Check all that apply)
       Persons with disabilities.
       Families of persons with disabilities.
       Professionals who provide services to persons with disabilities.
       Other. (Please list)

If your event is targeting a specific disability, please indicate here: (Examples: Autism, deaf, developmental disability, intellectual disability, mental illness, etc.)

* Estimated number of attendees:

Please share any additional information or details about the event:


Does this request fulfill requirements for a grant? If so, please explain.


You may expect a response from IDR in 7-10 business days.