Share: Facebook LinkedIn Twitter Email Couples / Partners Contact Form Information about you: Your First Name*Your Last Name*Please indicate your relationship to the individual with an Asperger/autism profile you are contacting us about.*Please check all boxes that apply to you.Self Partner/spouse Parent of adult Parent of teen Parent of child Grandparent Sibling Child (my parent has an Asperger/autism profile) Other family member Friend Educator Other professional No relationship, interested in learning more Information about the person you are contacting us about: First Name of person you are contacting us about*Last Name of person you are contacting us about*Demographic InformationWe ask for birthdate, gender, ethnicity, and race because of our commitment to equity and inclusion. This data has helped us to create innovative programming and recognize unmet needs. By filling out these fields, you help us gain insights on how we can help our entire community. Your personal information is protected by our privacy policy and is not shared with anyone outside of AANE.BirthdateFor person with an Asperger/autism/neurodiverse profile MM DD YYYY GenderFor person with an Asperger/autism/neurodiverse profilePlease selectFemaleMaleNon-binaryOtherEthnicityFor person with an Asperger/autism/neurodiverse profile. Please selectHispanic/LatinxNot Hispanic/LatinxRaceFor person with an Asperger/autism/neurodiverse profile. Please selectAfrican American or BlackAmerican Indian/Alaskan NativeAsianCaucasian or WhiteMultiracialNative Hawaiian/Pacific IslanderOtherPronounsFor person with an Asperger/autism/neurodiverse profilePlease selectHe/him/hisShe/her/hersThey/them/theirsYour Location Information:Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweStreet Address*City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPostal Code*Your Contact Information: Primary phone number*Type of phoneMobile Personal PhoneLandline Personal PhoneWork PhoneEmail* Enter Email Confirm Email SkypeHow did you hear about us?*Please selectInternet searchEmail from AANESocial mediaProfessional referralFamily/friend recommendationOtherIf Other*Is this your first contact with AANE?*Yes No How can we help?*What interests does the person you are contacting us about have?This helps us plan programming of interest to our communityWhat is your professional background?This helps us plan networking events for our communityAdditional options:Please email me an invitation to join the Spouse/Partner online discussion forum. Please send me a link to sign up for neurodiverse couples coaching. Please send me a link to learn more about couples/partners events or groups. EmailThis field is for validation purposes and should be left unchanged.