Information Request Form

The Institute conducts and facilitates research on the cause, prevention, and treatment of autism and similar severely handicapping conditions. ARI serves parents and professionals throughout the world by collecting, analyzing and disseminating information.

The Institute is supported by donations from organizations and concerned people. Donations are needed and are tax-deductible. Federal Exempt Designation: 501(c)(3).

Please complete the form below and mail it to us.
Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116, U.S.A.

Full Name: ____________________________________________________

Street Address: ________________________________________________

City/State/Zip: _________________________________________________

Telephone/Fax: ____________________________________________________

Parent/Professional/Other: ________________________________________

If parent, age of son/daughter: ______________________________________

___ I wish to subscribe to the ARRI newsletter for one year ($18.00/yr in U.S.; $20.00 foreign).

___ I am enclosing a donation of $________ to assist the work of the Autism Research Institute -- Federal Exempt Designation 501(c)(3).

TOTAL: __________________

Credit Card# -- #:_________-_________-_________-_________ Exp. Date__________
ARI accepts VISA, MasterCard, and Discover Card. We cannot process American Express.

Please make check/money order payable to: Autism Research Institute Payment must be in U.S. dollars.

Send order form and check/money order/credit card information to: Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116, U.S.A.

Our fax number is (619) 563-6840. If you fax us for information, please include your mailing address since our information packet is too thick to fax.