Aspiehelp / The Aspire Trust Membership Form
Aspiehelp is a peer support organisation for adults and teens with Asperger's Syndrome and other Autistic Spectrum Disorders. We are a registered charitable trust.
Become a member and access the Aspiehelp Library, come to our Social Nights, receive brochures, ask for counselling from our team, and/or have us mediate on your behalf. We can also accompany you when talking to employers, schools, doctors, and WINZ.
Name: *
Your answer
Gender *
Required
(Please let us know your preferred pronouns and title)
Your answer
Ethnicity *
Required
Mailing Address: *
Your answer
Postcode
Your answer
Email *
Your answer
Phone *
Your answer
Date of Birth
MM
/
DD
/
YYYY
How did you find us?
Your answer
GP's name and medical centre
Your answer
Diagnosis of Asperger's (or other Autistic Spectrum Disorder) *
Who diagnosed you (if applicable)
Your answer
Please bring a copy of your diagnosis with you to your first appointment, if you have it.
Membership costs $20 per year, or $30 for a family.
Donations of any amount are also welcome.
Our Patron is Stephen Mark Shore, PhD. We are proudly supported by the Rata Foundation.
Under the Privacy Act 1993, you may ask to see the information we have of yours, and you may ask us to update or remove your personal information. We require your information to provide demographic information when applying for grants and other funding, and retain it until your membership expires. Our Charities Services registration number is CC46192
Aspiehelp / The Aspire Trust (Inc)
Phone (03) 337-6337
Email info@aspiehelp.com
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