Autistic Self Advocacy Network

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Thank you for your interest. So that we can assist you with your enquiry, please complete and submit the form below. Please note that by completing and submitting this form, you are giving us your consent to securely pass on your information to Autistic Self Advocacy Network, and a free membership account will be created for you on our website.

Event

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Phone number We ask for your telephone phone number as a secondary form of contact. It is not mandatory, but may prove to be helpful as part of your application. Your phone number will only be used in relation to this application and will not be passed on to third parties.

Why do you want to participate?

Fundraising target: $3000

Our minimum fundraising target allows us to ensure we can raise vital funds for the work we do. We consider a range of factors when allocating our places, including personal reasons for choosing ASAN and your ability to achieve our fundraising minimum. Accepted runners must pay their own race registration fee and arrange and pay for their own travel and accommodations. We hope you join us!

How much do you pledge to fundraise?

How will you meet your fundraising goal?

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