Off Road Adapted RSVP (2023)

Name*

First Last

Email*

Phone*

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Please select which types of equipment you would like to try out:

Outrider Coyote with standard throttle control
Outrider Coyote with tripin throttle and steering
Terrain Hopper with joystick control
Action Trackchair
Bowhead Reach
Freedom Trax
Mountain Trike
Off-road handcycle/manual chair, if available.
I'm not sure which equipment I am interested in trying at this time.
I am attending the event as a member of the I AM community to learn more about the organization and off-road equipment, but I do not plan on trying the equipment myself.

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There may be an opportunity to use the Coyote Outrider during the week following the 25th through July 4th. Please indicate if you would be interested in utilizing this opportunity if it becomes available.

Yes, I would be interested.
No, I do not think I would be interested.
I'm unsure at the moment, but please contact me if the opportunity becomes available.

If you have a mobility impairment, please enter a brief description of it below (e.g. spinal cord injury/level, cerebral palsy, single-leg amputation, none):*

Please check the box below if you feel you will need assistance with transferring/set-up so that we can contact you for more information if necessary:*

Yes, I will need assistance.
No, I will not need assistance.

Please indicate the total number of people planning to attend this event:*

Please indicate the total number of people planning to participate in the lunch:*

Please indicate if you have any food restrictions (We will do what we can to accommodate your dietary need):*

Vegetarian
Vegan
None

Please list any food allergies that anyone attending may have:

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Please select if you are interested in fishing during this event:

Yes, I am interested in fishing.
No, I am not interested in fishing.

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I understand that no dogs are allowed at this event, and that I will need to sign a waiver to attend this event.

Off Road Adapted RSVP (2023)