Non-Member Event Form (Eggtravaganza)

Empowering Families, Building Community

Mothers and Autism Meetup
Non-Member Event Form

Full Name

Phone Number

Email Address

Address

Child's Full Name

Child’s Age

Diagnosis (if applicable)

Does the child require special accommodations or support?

Yes No

Please specify

Are there additional children with a diagnosis?

Yes No

2. Child's Full Name

Child’s Age

3. Child's Full Name

Child’s Age

How many immediate family members will attend this event?
Number of adults

Number of Children (Other than participant)

Please list child/children ages

Please indicate the event you would like to register for:

By participating in MAAM events, I understand that photography and video recording may occur. I agree to allow MAAM to use photographs or videos of me, my child(ren), and my family members for promotional and marketing purposes, including social media, website, and print materials.

I agree

Would you like to receive updates on future programs and events?

Yes No

By submitting this form, I acknowledge that I am registering as a non-member and agree to pay the $15.00 fee per event.

Signature