Seminar booking form To book a place on an Autism Seminar for Families that is funded by ‌‌ and is therefore FREE to parents/carers (maximum of two parents/ carers), please complete the form below and return to: Karen Abdy c/o NAS EarlyBird Centre Barnsley Road Dodworth, Barnsley South Yorkshire, S75 3JT E - help@nas.org.uk T - 07425 624 592 We will send confirmation details by email unless otherwise advised Please indicate which seminar you are interested in attending and how many places (up to a maximum of 2) that you require
Seminar Title Seminar Date Location
Name (parent/carer)
Email address
Contact Address (inc postcode)
Contact Telephone/ Mobile Telephone
Name (for 2nd place if required)
Please continue overleaf
Number of parents/carers
Name of child with an ASD
Date of Birth
Age
What is your son/daughters diagnosis? (Please circle) Autism
Asperger syndrome
Autism Spectrum Disorder
Other (please describe)
Date of diagnosis (approx)
How did you hear about this seminar? (please circle one of the following) NAS website Local Support Group
NAS help! team email School
NAS Branch Diagnostician
Other (please specify)
We will send confirmation of your place and directions approximately 2 weeks prior to the seminar. Bank Workers Charity The National Autistic Society (NAS) works in partnership with the Bank Workers Charity (BWC), a charity for bank employees and their dependents. If you (or your partner/ husband/ wife) work, or have worked in the UK banking sector, you can apply for a package of services and support funded by the BWC that is designed to meet your individual needs. If you would like to find out more contact Alan Carman on 0117 974 8411 Keeping in touch with you It really helps The National Autistic Society if we can keep you informed about our work and how you can help us. If you would prefer us not to contact you for this purpose, please tick this box EMAIL It helps us to keep in touch with you by email and by doing so this will keep our costs low. Please tick this box if you would be happy to receive such information from us by email
The NAS will not forward your details on to any third party.
The National Autistic Society is a data controller under the Data Protection Act 1998. The personal data you provide will be used for administration, statistical and other purposes connected with The National Autistic Society and autism. The NAS does not share your details with third parties without your express permission.