Family Support Services Membership Application

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					                                AUTISM SUSSEX FAMILY SUPPORT SERVICES
    Autism Sussex has created a NEW membership organisation for families in Sussex, which plans to offer:

                                              Parent Support Groups
                                            Advocacy and Signposting.
                                               Family Activity Days
                                    Behaviour Management Advice and Support
                                               Regular Newsletters
                                              Telephone Advice Line
                                      Drop In Information Resource Centres
                                                Parent Workshops
                                          One voice for Autism in Sussex

                    ***Membership £15.00 (see over for payment instructions)***

                             Family Support Services – Membership Application Form

Name:

Address:



Post Code:
Home Telephone:
Mobile:
Email:

Name of Person/s with ASC in the Family, Their Date of Birth:


Diagnosis:

Where did you hear about us:_____________________________________

As a member of Autism Sussex Family Support Ltd you will be an associate member, which is defined as a
‘non-voting’ member. However if you wish to be involved in the Board of Trustees of this new organisation,
then please contact: richard.brown@autismsussex.org.uk


Autism Sussex Family Support Ltd.
Company No: 7349652



What Services/ Support Are You Interested In?
Circle as Appropriate

Parent Support Groups?                                      Yes    /       No
Regular Newsletters?                                        Yes    /       No
Drop In Support and Advice for Parents/ Carers?             Yes    /       No
Telephone Advice Line?                                      Yes    /       No
Behaviour Management Advice and Support?                    Yes    /       No
Family Activity Days?                                       Yes    /       No
Sibling Support Groups/ Outings?                            Yes    /       No


Parent Workshops/ Training?                                 Yes    /       No
Please circle the courses you are interested in:

Understanding Autism
Understanding Asperger’s Syndrome
Understanding Challenging Behaviour
TEACHH
Puberty and Sexuality
Sensory Sensitivity
Establishing Routines and Structure

Please list any other topics/ courses that you would be interested in attending:


                                                                                                 ______
Please add any comments/ services that you may wish us to offer:




BANK MANDATE form: Please complete mandate and send with completed Family Support Services
application form to: Finance Department, Autism Sussex, Sussex House, Tills Yard, 19 High Street, Battle,
East Sussex TN33 OAE

YES/NO (please delete as appropriate)

OR

Send directly to bank and forward completed Family Support Services application form to:
Autism Sussex (Arundel Office), 1 London Road, Arundel, West Sussex BN18 9BH or
Email: janet.ginnaw@autismsussex.org.uk

YES/NO (please delete as appropriate)

				
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posted:10/4/2012
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