User account

Account information

Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Details

First Name *

Last Name *

First and last name will be shared with other visitors to the site.

Street Address (Home)

City (Home)

Postal Code (Home)

Country (Home)

Your state/province and country of residence will be shared with others so folks can find others in their community.

State (Home)

Phone-Phone (Primary)

Phone-Mobile (Primary)

Membership

Checking this box in your membership profile says you wish to be a member of Autism Asperger ACT Inc. and you accept all the conditions and responsibilities that membership of the organisations entails.

Research and Statistical Reporting

By checking this box you agree to letting Autism Asperger ACT Inc. and its agents aggregate your data with other member's data for reporting on people with ASD in the ACT.

FaHCSIA FOFMS Registration

By checking this box you agree to the ACT Autism Advisors using the information you provide to register you and your child with the FaHCSIA FOFMS* system.

If you are registering to see an Autism Advisor and for the FaHCSIA Helping Children with Autism Early Intervention service, please ensure you login once you receive your email. Then make sure you complete the Helping Children with Autism tab under My Account. *FOFMS is FaHCSIA’s online system used to manage access to the early intervention components of the Helping Children with Autism package that is funded by the Department of Families, Housing, Community Services and Indigenous Affairs as part of the Helping Children with Autism Package.

Person with ASD

Please check this box if you are a person formally diagnosed with an ASD.

Relationship to person with ASD

Interest in Helping Persons with ASD

Other Interest in ASD

Partner's Name

Willing to volunteer?

Yes

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