General Information

Please complete this form if you would like to be considered to be a speaker at the AANE/Aspire/FFDA spring conference on depression and Asperger Syndrome.

The form contains a few basic questions (name, address, etc.) and then provides you with a space to enter your personal story or account. The length of each talk will be 5-7 minutes.

* 1. Name

* 2. Street Address

* 3. City

* 4. Country

* 5. Email Address

* 6. Telephone Number

* 7. Is the above number your:

* 8. Website or Personal Blog

* 9. Will you be available to speak at the conference at Pine Manor College in Brookline, MA on Friday, March 14, 2014?

* 10. What is your relationship to the person about whom the account is written?

* 11. If you work with the person with AS in a professional capacity, what is your profession?
Please be as specific as possible.

* 12. How old is the person with AS?

* 13. Please use this space to document your experience with depression.

If you are writing about yourself, consider addressing the topics below:

-what symptoms you experienced
-how your functioning was effected
-how you decided to seek treatment, which treatments you tried
-what you feel helped and did not help
-how you think the Aspergers affected your depression and treatment
-impact on your family and friends
-response of clinicians

Clinicians and family members should consider those same topics when writing about their client or family member's experience of depression.

* 14. Describe any experience you have had with public speaking. (This is not a prerequisite for being chosen as a speaker.)