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) 874-2090 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. |