Contact Us (Parents + Family Members of Individuals up to Age 22)

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Contact information:

Your First Name*

Your Last Name*

Email*

Enter Email Confirm Email

Primary phone number*

Type of phone

Your Location Information:

Street Address*

City*

State*

Postal Code*

Country*

Affiliation

I am or think I may be a/an …*

Please check all boxes that apply to you.

First Name of the person you are contacting us about*

Last Name of the person you are contacting us about*

Is this your first contact with AANE?*

Yes
No

How did you hear about us?*

How can we help?*

Demographic information (optional)

By filling out these fields, you help us gain insight into how we can help our entire community. Your personal information is protected by our privacy policy and is not shared with anyone outside of AANE.

Birth Year

For the Autistic person

Gender

For the Autistic person

Pronouns

For the Autistic person

Ethnicity

For the Autistic person

Race

For the Autistic person

What interests does the person you are contacting us about have?

This helps us plan programming of interest to our community

What is your professional background?

This helps us plan networking events for our community

Would you like to receive periodic postal mail from AANE?

If this question is left blank you will receive postal mail from AANE.

Yes
No

Additional options:

Please email me an invitation to join Parents of Children online discussion forum.
Please email me an invitation to join Parents of Teens online discussion forum.

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Comments

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