Neuro Events Shropshire
Please note: This application form is for neurodivergent, socially independent individuals looking to date and/or make new connections locally.
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Name 
DOB
MM
/
DD
/
YYYY
Email address
Contact number
What events would you be looking to attend? 
Do you have a diagnosed neurodivergent condition? 
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Please indicate any neurodivergent conditions you have (diagnosed or self identified)
At what age did you receive a diagnosis (if any)?
Do you have any accessibility requirements we should know about? 
Are there any situations that may cause you discomfort during events?
What are you hoping to find through our events? 
If there is any additional information you wish to add please add it below
If you are happy to be contacted by Neuro Events Shropshire, please tick the box to give permission. 
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