Please fill out all information below. This information will be used to make seating accommodations for you and/ or your party. If you would like to discuss your seating needs feel free to call the Fine Arts Center Box Office at 413.545.2511. The Box Office is open Monday through Friday from 9:30am-5:30pm. The Box Office is closed for state and national holidays and follows the University's snow closings. Count of persons with accessibility needs in your party This form can collect accessibility needs for up to four people in your party. Since you have more than four please use the comment line in patron 1, 2, 3, and 4 to tell us how many people in your party have the accessible need you chose. Name: * E-mail: Phone Number: Event Name: * Order Number (if you happen to have it): Patron 1 Wheelchair - please remove existing seat Wheelchair - please leave existing seat Walker or cane No mobility impairment Power Wheelchair Yes No Is this a power wheelchair? Audio Visual Impairment Hearing Impairment Visual Impairment Other: If a needed accommodation is not listed, please specify your need(s): Patron 2 Wheelchair - please remove existing seat Wheelchair - please leave existing seat Walker or cane No mobility impairment Power Wheelchair Yes No Is this a power wheelchair? Audio Visual Impairment Hearing Impairment Visual Impairment Other: If a needed accommodation is not listed, please specify your need(s): Patron 3 Wheelchair - please remove existing seat Wheelchair - please leave existing seat Walker or cane No mobility impairment Power Wheelchair Yes No Is this a power wheelchair? Audio Visual Impairment Hearing Impairment Visual Impairment Other: If a needed accommodation is not listed, please specify your need(s): Patron 4 Wheelchair - please remove existing seat Wheelchair - please leave existing seat Walker or cane No mobility impairment Power Wheelchair Yes No Is this a power wheelchair? Audio Visual Impairment Hearing Impairment Visual Impairment Other: If a needed accommodation is not listed, please specify your need(s): Event Name Identifier
