Join us for A Conversation About MassHealthTuesday, March 10 from 6:30 – 7:30 PM Via Zoom.
I am a
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Parent
Professional
Parent/Professional
Autistic Person
Other
First & Last Name
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Town/City
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State
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Zip Code
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Name & Age of Individual with ASD
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.
DDS Eligibility
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DDS
Autism Division
N/A
I give Community Autism Resources permission to have myself, my family members, or any person(s) that I have registered for this Event to be photographed/ videotaped for educational/publicity purposes only:
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Yes
No
I understand that participation in this event is at our own risk and will not hold Community Autism Resources liable for personal injury or loss/damage of personal property:
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Yes
Email (confirmations will be sent to this address)
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Telephone Number (please leave best number to be contacted at)
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I hereby agree to notify CAR if I am unable to attend this event (either via email or phone listed on confirmation). Notification should be received prior to the event or up to 24 hours after the event whenever possible. If such notification is not received by CAR, I understand that I will be unable to attend CAR events for 6 months from the date of this event.
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Yes
Comments or questions you have (Cannot guarantee they will get to all of them).
Submit
Should be Empty: