Growing Up Confident Registration

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

If you require accommodations (captions, etc.) please specify here. These requests must be made at least two weeks in advance of the event.

Registration rates

Please select your registration rate.*

Non-member ($59.99)
AuSM Member or joining today ($49.99)
I would like to request the scholarship rate ($39.99)

Scholarship Application

AuSM is committed to equity in our programming by providing scholarship opportunities for participants who face barriers to participation. Scholarships are provided as discounts for fee-based programs not covered by disability waivers. Scholarships are only available to Minnesota residents. Requesting a scholarship requires you to provide your mailing address, but AuSM will never ask for your immigration status. We strongly encourage individuals from historically marginalized communities to apply.

Low Income is defined as household income less than 100% of the Federal Poverty Guidelines (a single person earning less than $15,650, increasing by $5,500 for each additional person).

Rural Minnesota is defined as any Minnesota county other than Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties.

I am...*

Autistic
Low Income
Black, Indigenous, and People of Color (BIPOC)
LGBTQIA+
Rural Minnesota Resident
None of the above

Please select all that apply.

Household Income:*

Household Size*

County*

You are not eligible for the scholarship rate. Please select a different rate.

Membership

I am joining AuSM or renewing my membership today.*

Membership Category*

Household: $60
Individual: $40
Autistic Individual: $20
Non-Profit Agency/Company: $150
For-Profit Company: $350

AuSM offers a reduced rate to improve the accessibility of our workshops for our larger community. Please answer these questions to determine if you are eligible for the reduced rate.

Household Members

Please share some information about the other members of your household. If you have more than 6 members in your household, please call 651.647.1083 or e-mail info@ausm.org to provide information about all members of your household.

Please select number of members in your household membership including the participant listed on this form.*

Name of second member in household.*

First Last

Contact information is the same as participant's listed above.

Yes

Address of second member in household*

Street Address Address Line 2 City State ZIP Code

E-mail of second member in household*

Date of birth of second member in household*

Name of third member in household.*

First Last

Contact information is the same as participant's listed above.

Yes

Address of third member in household*

Street Address Address Line 2 City State ZIP Code

E-mail of third member in household*

Date of birth of third member in household*

Name of fourth member in household*

First Last

Contact information is the same as participant's listed above.

Yes

Address of fourth member in household*

Street Address Address Line 2 City State ZIP Code

E-mail of fourth member in household*

Date of birth of fourth member in household*

Name of fifth member in household*

First Last

Contact information is the same as participant's listed above.

Yes

Address of fifth member in household*

Street Address Address Line 2 City State ZIP Code

E-mail of fifth member in household*

Date of birth of fifth member in household*

Name of sixth member in household*

First Last

Contact information is the same as participant's listed above.

Yes

Address of sixth member in household*

Street Address Address Line 2 City State ZIP Code

E-mail of sixth member in household*

Date of birth of sixth member in household*

Payment

Please check with your county case manager to learn if your select class can be paid for under the Community Access for Disability Inclusion (CADI); Brain Injury (BI); Community Alternative Care (CAC); Consumer Support Grant (CSG); Family Support Grant (FSG); or Developmental Disability (DD) waivers. By registering for an AuSM class, you agree to pay in full any amount not covered by the third party payer.

Total

$0.00

If you have a coupon code, please enter it here.

Please select your payment type*

Pay now by credit card
Share third party payer information to be invoiced

Donating to AuSM helps support programs like this. If you'd like to make a donation, enter the amount here.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Third Party Payment

By completing this form, you agree to pay in full any amount not covered by the Third Party Payer.

Third Party Payer Organization Name*

Third Party Payer Contact Name*

First Last

Third Party Payer Address*

Street Address Address Line 2 City State ZIP Code

Third Party Payer E-mail*

Third Party Payer Phone*

Growing Up Confident Registration

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Registration rates

Scholarship Application

You are not eligible for the scholarship rate. Please select a different rate.

Membership

Household Members

Payment

Third Party Payment