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Membership of A4 is free. A4 distributes its A4 Update (newsletter) via e-mail every month or two. Occasionally, we send out other information via email. If you would like to receive A4 information and Updates, please complete the online membership form below. When you have finished, please click on the "Submit" button near the end of this form.

A4 members need to provide name, email address and the state where you live. The other information is optional. Please, only provide it if you feel comfortable doing so.

 

Information marked with an * is required.
       

Given Name/s:     

*

Surname:

 *

E-mail address:

 *
I prefer to receive A4 Updates (the newsletter) via: *

 
 
The following information is OPTIONAL.  Only provide the information below if you are comfortable doing so.  We are collecting this information for use by A4 so that it can operate effectively as a grassroots organisation.  This information will only be used for A4 to contact you about it's activities and not for third party distribution.
       
Person with ASD Parent/Family Carer Professional
   

Street Address:

 

City/Suburb:

State/Territory: 

*

Country:

Postcode:

Home Number: 

Work Number: 

Fax Number:

Mobile Number:

Electorates (if known):

     

Federal:

State: 

       

Do you have any interests in particular ages or groups?
       
Pre-school   Young Adult  
Primary School   Adult  
High School   Senior  
       
Aspergers   Atypical (PDD/NOS)  
Classic   Other
       
 
A4 will at times be seeking assistance with specific projects.  If you are prepared to become further involved directly in ASD advocacy please mark the boxes below where appropriate.  Formal qualifications and experience are not required for you to register your interest.
       
Public Speaking   ASD Education  
Fund Raising   ASD Diagnosis  
Media Work   ASD Treatment/Therapy  
Website Maintenance   Lobbying  
Policy Development   Legal Review  
Graphic Design   Liaison with Profession/s  
Report Writing   Local Contact/Organiser  
Letter Writing   Other 
       
  By completing this form you will be placed on the mailing list for future mail outs and to receive the A4 Update.

 

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Copyright © 2003-2007 A4 - Autism Aspergers Advocacy Australia
Last modified: 10-Jun-2008