About Autism, About Me Registration Form

1. Fill in the form & click submit
2. I will email you back with either:

An invoice (privately funded)
A service agreement (NDIS)

If you have any concerns with providing these details to me or if you are stuck you can also get in touch with me directly via email.

Name

First Name

Last Name

Email

This is where I will send all correspondence, including the zoom links

Address

So I know where to send your resource pack - PO Box is okay too.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

AusPost/courier company requires this when sending parcels

(###)

###

####

Payment methods

The cost of the group is $750. This can be paid either through a deposit of $300 with the remainder due when the group starts or through weekly invoice (NDIS only).

I will pay a deposit to secure my place in the group

I will sign a service agreement to secure my place in the group (NDIS only)

Your NDIS number is required for the service agreement.

Please enter the invoice where your NDIS invoices should be sent (e.g. plan manager or your own)

Select the group you want to join

Message (Optional)