State of Vermont - Environmental Assistance Office



*Please fill out the fields below and click the [Submit] button to obtain a user pass for the use of Other Power Driven Mobility Devices (OPDMD) on Agency of Natural Resources Land*
Name:
Address:
Town:
State:
Zip:
Phone#:
Email Address:
Date of Birth:
Duration of pass:
What classes of OPDMDs will you be using:	CLASS I: Small (vehicle width less than 36 inches) CLASS II: (ATVs, vehicle width of 36 to 50 inches) CLASS III: (UTV, autos, vehicle width more than 50 inches)
Region (select all that apply)	North-EastNorth-WestSouth-EastSouth-WestCentral
Please tell us some trails/areas that you will be accessing and what kind of activities you will engage in so that we can better target our efforts to increase accessibility:
Please note that all OPDMD use is restricted to 3 mph which is the average pedestrian walking speed. This is in order to provide a safe environment for all users. To view the full Agency of Natural Resources policy on OPDMDs please see http://fpr.vermont.gov/accessibility By clicking the [Submit] button, you hereby affirm that you have a mobility disability.