FEAT/RI LogoFamilies for Effective Autism Treatment of Rhode Islandblank image
P.O. Box 8460 Cranston, RI 02920
Telephone: (401) 886-5015  |  Fax: (401) 739-7384blank image
Email: featri@gmail.com  |  Web Site: www.featri.org blank image



On-Line FEAT/RI Membership Application

*Denotes required fields.

Date:

New Member:     Renewal

Select Membership type:
Parent/Family Member/Student/TA = $35.00
Professional Individual = $50.00
Professional Agency Group = $75.00

Full Name*:

Street Address:
City:   State:   Zip Code: blank image

Home Telephone:   Work Phone:
Fax:   Email*: blank image

Relationship to Autism:
Parent: blank image
Relative: Relation: blank image
Professional: Type: blank image
Other: Describe: blank image

Child’s Name (optional):
Child’s Birthday/age (optional): blank image

Agency Affiliation/ABA Provider:

Please indicate any programs/ideas you would like to see FEAT develop:



Select your payment method (continues on next page after application is submitted):

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Click the Submit button, below, to continue your application:

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FEAT/RI LogoFamilies for Effective Autism Treatment of Rhode Islandspacer image
P.O. Box 8460 Cranston, RI 02920
Telephone: (401) 886-5015  |  Fax: (401) 739-7384blank image
Email: featri@gmail.com  |  Web Site: www.featri.org blank image

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