Newsletter/Email Sign-Up Thank you for your interest in AANE. Please check the types of email communication you'd like to receive from AANE. To receive only the Monthly Newsletter complete these 3 questions - Question #1 - leave the Monthly Newsletter boxed checked Question #2 - enter only your email Skip to Question #9 - enter the characters you see before you click "Submit" To receive additional emails relevant to you fillout all questions (Demographic questions 5 - 8 are optional). 1. Question - Not Required - Please send me the following types of emails for: Monthly newsletter only Weekly emails for Adults with Asperger/autism profiles (and monthly newsletter) Weekly emails for Educators of students with Asperger/autism profiles (and monthly newsletter) Weekly emails for Family/Friends of individuals with Asperger/autism profiles (and monthly newsletter) Weekly emails for Other professionals working with individuals with Asperger/autsim profiles (and monthly newsletter) 2. Please provide only your email below to receive just the Monthly Newsletter. To receive the Monthly Newsletter and other types of emails, please fill out all the information below Title: Mr. Ms. Mrs. Miss Dr. Required First Name: Last Name: * Email: Required Street 1: Street 2: City: State / Province: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AS FM GU MH MP PR PW VI AA AE AP AB BC MB NB NL NS NT NU ON PE QC SK YT None Required ZIP / Postal Code: Country: United States Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivarian Republic of Venezuela Bonaire, Sint Eustatios and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic People's Republic of Korea The Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Federated States of Micronesia Fiji Finland The Former Yugoslav Republic of Macedonia France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Plurinational State of Bolivia Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles S. Georgia & S. Sandwich Isls. Sierra Leone Singapore Sint Maarten (Dutch) Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania Uruguay USA Minor Outlying Islands Uzbekistan Vanuatu Viet Nam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Required Phone Number: If you respond and have not already registered, you will receive periodic updates and communications from Asperger/Autism Network. 3. Question - Not Required - Please indicate your relationship to an individual with an Asperger/autism profile (check all boxes that apply): A - Adult with an Asperger/autism profile B - Parent of adult with an Asperger/autism profile C - Parent of teen with an Asperger/autism profile D - Parent of child with an Asperger/autism profile E - Grandparent with an Asperger/autism profile F - Partner/Spouse in a neurodiverse relationship G - Sibling of an individual with an Asperger/autism profile H - Child (my parent has an Asperger/autism profile) I - Other family member of an individual with an Asperger/autism profile J - Educator of students with Asperger/autism profiles K - Other professional working with individuals with Asperger/autism profiles L - Friend of an individual with an Asperger/autism profile M - No relationship, but interested in learning more about Asperger’s and similar autism spectrum profiles 4. Question - Not Required - How did you hear about us: Please select response Conference/Educational Event Email from AANE Family/Friend Internet Search Other Parents Print Media Educator/Professional Resource Fair Social Media Demographic information These are optional questions. We ask for birthdate, gender, ethnicity, and race because of our commitment to equity and inclusion. This data has helped us to create innovative programming and recognize unmet needs. By filling out these fields, you help us gain insights on how we can help our entire community. Your personal information is protected by our privacy policy and is not shared with anyone outside of AANE. 5. Question - Not Required - Please indicate the pronouns of the individual with an Asperger/autism profile: Please select response He/him/his She/her/hers They/them/their 6. Question - Not Required - What is the birthdate of the individual with an Asperger/autism profile? Month Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Year 2036 2035 2034 2033 2032 2031 2030 2029 2028 2027 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 7. Question - Not Required - I identify my gender as: (For person with an Asperger/autism/neurodiverse profile.) Female Male Non-binary Other 8. Question - Not Required - I identify my ethnicity/race as: (For person with an Asperger/autism/neurodiverse profile) Please select response Africian American / Black American Indian / Alaskian Native Asian Caucasian / White Hispanic / Latino Multiracial Native Hawaiian / Pacific Islander Spam Control Text: Please leave this field empty