S2S Non-Member Program Form – Mothers and Autism Meetup

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Mothers and Autism Meetup

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Programs
Events
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Upcoming Events
About
Contact
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S2S Non-Member Program Form

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S2S Non-Member Program Form

Empowering Families, Building Community

Mothers and Autism Meetup
S2S Non-Member Program Form

Thank you for joining our community! Please complete this form to help us better understand your needs and tailor our program to support you.

Full Name

Phone Number

Email Address

Address

What session(s) are you most likely to attend?

IEP Advocacy Effective Communication Routine Building w/ ABA Techniques Nutrition & Gut Health Fueled By Care- In-person Caregiver Brunch (Chester, VA)

Are you registering as a caregiver?

Yes No

How are you connected to the autism community?

Do you have any challenges you’re currently facing on this journey?

Yes No

Please share briefly:

Do you have any special accommodations or needs?

Yes No

Please specify:

Which sessions are most likely to attend?

IEP Advocacy Effective Communication Routine Building w/ ABA techniques Nutrition & Gut Health Fueled By Care- Caregivers Brunch

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

Yes No

By checking the box, I acknowledge that

I am registering as a non-member and agree to pay the $15.00 fee per program. 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.

Signature

Date

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P.O. Box 947 Colonial Heights, Virginia 23834

Phone:804 895 8930

Email: info@mothersandautismmeetup.org

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