Join Us

By submitting this form you agree to us holding your information on file

If you require help to fill in this form, please phone / text Susan on 07748 350587

First Names*

Last Name*

Name you like to be known as

Date of Birth

Email*

Address

Postcode

Contact Number

Preferred method of communication

Name and Tel number of someone to contact in an emergency ( for example: Parent, family member or reliable friend)

Approx. Date of Autism Diagnosis

Any Allergies

Likes / Interests

Dislikes / Things that annoy you

What do you hope to gain from being a member of Team Autism? (for example: Friendship, Social Activities, Advice, Support )