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The A World UK CIC
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Membership Application Form
Full Name (Parent/Guardian)
Email address
Full Name of Recipient who has an Autism Spectrum Diagnosis
Attach Autism Spectrum Diagnosis evidence document
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The recipent must live within one of the council boroughs (who you pay your council tax to) from the drop down menu (please select)
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Please provide proof of address dated within the last 6 months
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How many adults 18+ are you wanting to be included on your membership?
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How many children 0-17Yrs are you wanting to be included on your membership?
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