Support Group Registration Application In an effort to increase the number of support opportunities available to families affected by autism across Greater Wisconsin, the Autism Society of Greater Wisconsin is pleased to offer a path for support groups to register with the Autism Society of Greater Wisconsin. Prior to completing this application, please make sure to: Review the Autism Society of Greater Wisconsin's 53 county service area. Only support groups in these 53 counties are eligible to apply. Review the full registration process including, eligibility, expectations, and benefits. Question Title * 1. I have reviewed the Autism Society of Greater Wisconsin's service area and confirm that our support group is located within the 53 county area. Yes No Question Title * 2. Support Group Contact Information Name * Organization Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address * Phone Number * Question Title * 3. Support Group Name Question Title * 4. Location of Support Group Meetings Question Title * 5. Purpose of Support Group Question Title * 6. How long has this group been meeting? We haven't had a meeting yet Under a year One year or longer Question Title * 7. Other relevant comments: Thank you for your interest in becoming an Autism Society of Greater Wisconsin Registered Support Group. A staff member will contact you within one week of submitting this form. If you have any questions in the mean time, please contact Kirsten Cooper at kcooper@autismgreaterwi.org or 920-215-3303. Done