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MAIER Parent Packet Request
Thank you for your interest in receiving the MAIER Parent Packet. Please fill out the form below and we will respond to your request within 7-10 business days.
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* Indicates required question
Name (First and Last)
*
Your answer
Agency or Organization (if applicable)
Your answer
Mailing Address (Street or PO Box)
*
Your answer
City or Town
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone number
*
Your answer
Email address
*
Your answer
Please indicate your interest in the Parent Packet
*
Individual on the autism spectrum
Parent
Other family member
Educator
Professional
Agency
Medical or Developmental Practice
Other
Required
Please indicate if you would like us to include a set of the Maine Parent Guide to Autism Spectrum Disorders with your packet.
*
Yes
No
Would you like us to add you to MAIER's mailing list to receive electronic news and announcements of interest to families and caregivers?
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Yes, add me to MAIER's mailing list to receive electronic communications from MAIER.
No, do not add me to MAIER's mailing list.
I am already on MAIER's mailing list.
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