August

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August

Thank you for joining the Autism Society of Greater Phoenix Birthday Club.

Requests MUST be received by the 24th of the previous month.

Autistic individuals of any age are eligible for this program. Applicants MUST reside in Arizona.

Please make sure the month listed in the title matches the individual's birthday month before filling out the Birthday Club request.

Incomplete requests will not be fulfilled.

電子郵件 *

Full Name of Person Receiving Card *

Age Group of Person Receiving Card: *

Child 0-12

Teen 13-17

Adult 18 +

Street Address of Person Receiving Card

*include apartment number if necessary

City *

Zip Code *

What is your relationship to the Birthday Club member? *

Self

Parent/Caregiver

Sibling

Extended Family Member

Friend

Educator

Therapist

其他：

必填

I attest that the Birthday Club member has a diagnosis of Autism and that the information above is correct. *

Yes

I understand that this form will need to be filled out each year to ensure address information is correct. *

Yes

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