Autism Network International

Subscription Form

Name _________________________________ Birthdate _____

Address ____________________________________________________

City, State, ZIP _______________________________________________

Phone number ___________________

Interests __________________________________________________


Circle one:

AUTISTIC PERSON                               FAMILY MEMBER _________________

__ informally or self-diagnosed                                                                  (Relationship)
__ formally diagnosed (by a professional)

"COUSIN" _________________________________________

(Person with a documented developmental neurological abnormality
having a significant overlap with autistic characteristics: for
example, hydrocephalus, Williams syndrome, Tourette syndrome)

TEACHER _______________ OTHER _________________

(Age and level of students)

Enclose subscription fee of $15 ($20 overseas), in U.S. funds, and
return to ANI, P.O. Box 35448, Syracuse, New York 13235-5448.


Joining ANI


To join ANI, please fill out the form above and send it to:

Autism Network International 
P.O. Box 35448 
Syracuse NY 13235-5448 

Our Voices
Membership in ANI includes a subscription to the newsletter, Our Voices, published quarterly. The cost for four issues of Our Voices is $15 in the U.S., Canada, or Mexico, $20 overseas, payable in U.S. funds.
For a sample issue, send a request, along with name, address, and $5. If you
then decide to subscribe, the $5 will be credited toward your subscription.

ANI Return to the ANI home page.
The ANI web site was last modified Wednesday 6 March 2005. Comments, questions, and suggestions concerning this site should be addressed to the webmaster at ANI. Regrettably, due to the webmaster's heavy workload, personal replies may not always be possible.