AAW Equipment Reservation Form - Individuals and Organizations

Please review all the required forms listed under the "Requirements" tab and discussed on the Reservation page: http://www.accessabilitywi.org/reservations

For safety reasons we require at least an 8" clearance from the ground to the hitch once the trailer is attached. As such we suggest you use a midsize SUV, a van, or a truck to ensure the appropriate clearance and safety.

***We have a right to refuse check out for any safety reason.***

Phone: 608-886-9388 - www.AccessAbilityWI.org - Email: AAW@AccessAbilityWI.org

Email address *
Full Legal Name of person checking out AAW's outdoor wheelchair(s) *
Your answer
Please provide WI DNR Customer #: of person checking out the outdoor wheelchair(s) *
Your answer
We require this due to DNR grant reporting. If you have questions about the WI DNR Customer #, please refer DNR- http://dnr.wi.gov/education/outdoorskills/idcheck.html
There is no fee to acquire a DNR Customer #.
Street Address *
Your answer
City, State, & Zip *
Your answer
Phone: *
Your answer
Kind of phone *
Is the person using the chair a minor: *
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