International Network of Designers with Disabilities Application Form

We invite you to join the network by completing this form. This information is confidential, and will only be shared with other members of the Network with your permission if there is an interest in sharing any information. If you have questions, please email Elaine Ostroff (eostroff@HumanCenteredDesign.org).

Today's Date:

First Name:

Middle Initial:

Last Name:

Affiliation (Organization/School/Company):

Street Address:

Street Address (line 2):

City:

State:

Postal Code:

Phone/TTY:

Fax:

E-mail:

Please leave this field empty:

Major professional field of practice or study (select):

If other:

Please briefly describe the nature of your disability*; and any accommodations that are useful in your experience as a designer:

* If you do not have a disability, please note that the Network is specifically for designers with disabilities. You might consider joining the Access to Design Community. See: Join the Community

Please briefly describe recent professional projects or job description:

We encourage network members to share what they would like to see the network do and what benefits they would like to derive from joining. Please share any thoughts you may have about the Network:

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International Network of Designers with Disabilities Application Form