Joining the Scottish Autism Network

Scottish Autism Service Network
Membership Form

Title:
   Please state other

Name:

Job Title (if applicable):

Name of organisation/service (if applicable):

Nature of organisation/service (if applicable):

Address:



Postcode/Zip Code:

Telephone Number:

Email:

Confirm Email:

I am (please tick one)...
a person with an ASD
a partner of someone with ASD
a carer of someone with ASD
a parent of someone with ASD
a practitioner working in the field of ASD

Please read the SASN terms and conditions

I have viewed and agreed with the terms and conditions

I give permission for my details to be passed on to carefully selected similar organisations, services and professionals for the purpose of my receiving further information about ASD*

*please note that in certain circumstances we may share data with similar organisations. However, data will not be sold to other organisations and we will request that any data passed on is handled confidentially and sensitively and in accordance with the Data Protection Act 1998.

Please return this form to: Scottish Autism Service Network, National Centre for Autism Studies, University of Strathclyde, Room D002, David Stow Building, 76 Southbrae Drive, Glasgow, G13 1PP

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