Registration Form
Please print form and mail with check or money order to :
Autism Asperger Associates of Michigan LLC
7027 10 Mile Rd Rockford, MI 49341
(616) 780-1358
Name: ______________________________________________
Child's Name: ____________________________________________________
Child's Birthdate: ________________________________________________
Address: ____________________________________________
_________________________________________________________
Phone: ____________________________
Please refer to current class offerings and fill in the information below:
Class or Workshop Name: __________________________________
Dates: _____________________
Fee: _____________________
Class or Workshop Name: __________________________________
Dates: _____________________
Fee: _____________________
Please note, there are no refunds once a series of classes begins. Workshop fees will be refunded if cancellation is received at least 2 weeks prior to workshop.
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