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Membership Application

ACU Membership Application

Below is an Autism Council of Utah Membership Application.  Please email the following information to ~ autismcouncilofutah@gmail.com

First Name:

Last Name:

Email:

Agency/Organization:

City:

State:

Phone:

Role:

What is your area of interest in Autism?

What can you contribute to the Autism Council of Utah?
Please tell us about your vision for people with Autism in Utah.
If you are associated with an agency or organization, how does the mission relate to the mission of the Autism Council of Utah?

What committees are you interested in participating in?

Thank you!

Autism Council of Utah