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Federal Relay Service (FRS)

Open to Federal Agencies Only

FRS REGISTRATION FORM

Click here to return to FRS Main Page

You must be a federal employ to register for this seminar.

9th National Training Conference for Deaf and Hard of Hearing Government Employees at the Natcher Conference Center National Institutes of Health, Bethesda, Maryland. Call-in information will be provided with registration confirmation.

This registration applies only to the NTC conference at NIH - March 17-19, 2003:

NTC 9th National Training Conference for Deaf and Hard of Hearing Government Employees
at the Natcher Conference Center National Institutes of Health,
Bethesda, Maryland

Session Date and Timing:march 17-19, 2003, .

Fill in all the information below and press the Submit button. Information marked with a "*" is required. If you do not fill it in, you will not be registered.

Hearing Impaired: Contact the Federal Relay Service at 1-800-877-8339.

   1. First Name *                      

   2. Middle Initial                      

   3. Last Name*                      

   4. Title*                                   

   5. Agency Name*                 

  6. If other, list the agency      

   7. Work Street Address      

                                                   

   8. City                                     

   9. State	                                 
                       


   10. Zip Code                         

   11. Fax                                   

   12. Email Address*

13. Disability* (Check Only One) Deaf HOH Speech Disabled Other NA

14. Service Type* (Rank in Order of Use)

       VCO
       HCO
       Speech to Speech
       VRS
       Two-line VCO
       CapTel
       TTY
       ASCII
       Voice
       Deaf
       Blind
       Other

15. eNews* - Like to Subscribe Yes No

If Yes, Please provide your email address

16. Online Survey Panel* Yes No

If Yes, Select Service type

     VCO
     HCO
     Speech to Speech
     VRS
     Two-line VCO
     CapTel
     TTY
     ASCII
     Voice
     Deaf
     Blind
     Other

17. Computer* (Check only one)                                 Windows Mac

18. Internet Access* (Check only one) Yes No

19. Work in office or from home* (Check only one) Yes No

20. Work in US or Overseas* -International (Check only one) US International

If International, list the country

21. How often do you use the Federal Relay?*

   Daily
   Monthly
   Once a Month
   Less than a Month
   Never Used
   Other - Please Specify

22. How did you first hear about the FRS?*

   Conference/ Trade Shows
   Agency Presentations
   FRS Brochures
   Friends/ Relatives/ Business Associates
   Other, Please specify

   23. Please rate the OVERRALL satisfaction with the FRS service *

   Extremely satisfied
   Satisfied
   Unsatisfied, please specify
   Extremely unsatisfied, please specify

   24. How does the service from the FRS compare with service from state relays? *

   Much better
   Somewhat better
   About the same
   Somewhat worst
   Much worse

   25. Disability* (check one)

   deaf
   hard of hearing
   speech disabled
   other
   non applicable

26. Service Type* (VCO, HCO, speech-to-speech, VRS, Two-line VCO, Captel, TTY, ASCII, Voice, Deaf-blind, other
(text only and rank in order for use)

       VCO
       HCO
       Speech to Speech
       VRS
       Two-line VCO
       CapTel
       TTY
       ASCII
       Voice
       Deaf
       Blind
       Other

27. Have you ever recommended FRS to others?*

   Yes
   No, please specify

28. What state do you make your FRS calls from?*

Choose from the drop down State Bar Listing

29. If you have encountered any problem using FRS, was it resolved to your complete satisfaction? *

   Yes
   No
   Did not encounter any problems
   Other, please specify

30. Do the current FRS communications options/features for placing your call meet your current needs.? *

Yes
No, please specify

31. What new assistive technology services and/or features would you like to be offered through the Federal Relay that will meet your needs and requirements now and in the future? *

32. Comments *

When you hit the "submit button" the information you have filled in the form will appear in your email application window. Please verify the information and then send the email. Thank you for participating.

After the form has been received you will be sent a confirmation of your registration and call-in information for this session.
Click here to return to FRS Event Page

Information gathered for registration purposes on this web site will be used for informational purposes by the GSA/FTS Office of FRS, and may be passed on internally to other GSA offices in an effort to better serve the needs of the user. Information will be kept confidential. It will not be sold, rented, or exchanged with any other government agency or entity of any kind unless the user is first notified and expressly agrees.

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