April
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.
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Email *
Full Name of Person Receiving Card *
Age Group of Person Receiving Card: *
Street Address of Person Receiving Card
*include apartment number if necessary
*
City *
Zip Code *
What is your relationship to the Birthday Club member? *
Required
I attest that the Birthday Club member has a diagnosis of Autism and that the information above is correct. *
I understand that this form will need to be filled out each year to ensure address information is correct. *
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