Posted by on Nov 18, 2013 in Medical Facilities, Schools | 0 comments


Today’s Date:

Name of Requesting Organization:

Organization Address:
Contact Person: Phone:
Email Address: Fax:
Date of Event:
Time of Event:
Location of Event (please include full address):
Audience Size: # of Parents # Of Professionals
Purpose of Event/Topic:
Specific speaker requested? Specific topics to cover?
The Autism Society of Illinois  provides information & training on the special education
rights of children with disabilities, at community locations through out the Chicago Metropolitan area.
ASI Provides training to groups of 10 or more participants, at no cost to parent-only groups; and a
honorarium fee for professional-only groups. Training to mixed groups of parents and
professionals is available at no cost.
*The The Autism Society of Illinois cannot guarantee that a speaker will be available on the dates that you
Please return this form to The Autism Society of Illinois:
♦ 2200 S. Main Street, STe. 203, Lombard, IL 60148 ♦ Tel. 630.691.1270 ♦ Fax 630.932.5620 ♦ or email to

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