{"id":2950,"date":"2025-11-18T01:34:45","date_gmt":"2025-11-18T06:34:45","guid":{"rendered":"https:\/\/lamaisondelautisme.ca\/?page_id=2950"},"modified":"2026-01-12T23:02:00","modified_gmt":"2026-01-13T04:02:00","slug":"formulaire-membre-en","status":"publish","type":"page","link":"https:\/\/lamaisondelautisme.ca\/en\/formulaire-membre-en\/","title":{"rendered":"Formulaire Membre EN"},"content":{"rendered":"\n
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Become a member, it’s free<\/h1>\n\n\n\n
Version en fran\u00e7ais<\/a><\/h5><\/div>\n\n\n\n

Simply complete the form below to gain access to our activities, <\/h2>\n\n\n\n

including support groups, meetings, and special events. Your membership also helps us show the impact we have in your lives.<\/p>\n<\/div>\n\n\n\n

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    Email *
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    First name *
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    Last name *
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    What is your preferred language for our services? *
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    What is your gender identity? *
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    How do you want to be addressed?
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    Which city do you live in? *
    \n<\/span>\n<\/p>\n

    Where do you live? *
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    \n\t

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    Specify us :
    \n<\/span>\n\t<\/p>\n<\/div>\n

    Which group(s) do you belong to? *
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    What is your year of birth? *
    \n<\/span>\n\t<\/p>\n\t

    At what age did you have your diagnosis, or did you suspect you were autistic, if any? *
    \n<\/span>\n\t<\/p>\n\t

    Other diagnoses? (To provide services according to your needs.)
    \n

    \n\t\t

    Specify :
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n\t

    Which of these choices best describes your situation?
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    \n\t\t

    Specify :
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n\t

    What kind of support do you need to be able to live independently? *
    \nYour answers will help us build a program tailored to members needs.
    \nI would like:
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    \n\t\t

    Specify :
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n

    \n\t

    Specify your link with an autistic person: *
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    Do you know their year or birth?
    \n<\/span>
    \n<\/span>
    \n<\/span>
    \n<\/span>\n\t<\/p>\n\t

    At what age did this person have their diagnosis, or did they suspect they were autistic, if any? *
    \n<\/span>\n\t<\/p>\n\t

    Other known diagnoses of this person?
    \n

    \n\t\t

    Specify:
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n\t

    What kind of help does this person need to be able to develop their autonomy? *
    \nYour answers will help us build a program tailored to the needs of our members.
    \nThat person would need:
    \n

    \n\t\t

    Specify :
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n\t

    What kind of help would you need?
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    \n\t\t

    Specify:
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n

    \n\t

    What kind of environment do you work in? *
    \nHealth\/Medical<\/span><\/span>Education<\/span><\/span>Support\/Respite<\/span><\/span>Organization\/Federation<\/span><\/span>Other<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t

    \n\t\t

    Specify :
    \n<\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n

    What kind of support are you looking for?
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    \n\t

    Specify :
    \n<\/span>\n\t<\/p>\n<\/div>\n

    Help the Autism House fulfill its mission by:
    \n

    \n\t

    Specify :
    \n<\/span>\n\t<\/p>\n<\/div>\n

    Would you like to receive our newsletter? *
    \nYour name will be added to our mailing list.
    \nYou will receive our newsletter with the latest news, activities of the month and other useful information about Autism house.
    \nYou will be able to unsubscribe at any time if you no longer wish to receive our communications but you will continue to receive those of the services if you are part of our members.
    \nSubscribe<\/span><\/span>Unsubscribe<\/span><\/span><\/span><\/span>\n<\/p>\n

    I understand that : *
    \nThe information you provide to us when you join is kept confidential and secure. They are accessible only to members of the executive of the board of directors of the Maison de l\u2019autisme. They are protected against unauthorized access. Your personal data will never be shared individually. Certain information may be used anonymously for statistical purposes, in particular for the preparation of the annual report of the organization. No personally identifiable data will be published.
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    We value your input. Is there anything else you'd like to share.
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