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SPECIALNEEDS
INMYCITY
Helping Families Find Special Needs Information
About Us
Read Aloud
Events
Join us for November 2, 2024 Health & Wellness Conference
2023 | 5th Annual Health & Wellness
Parent Support Meetings
Calendar
Links
Parent Support Groups
Podcast
Blog
Community & Online Resources
Community Agencies and Programs
Day Programs/ Child Care
Deaf and Blind Services
Educational
Legal
Medical Facilites
Medical supply and loan closet services
Parent Support Groups
Recreational
Residential Group Homes
Sibling Issues/Special Needs Siblings
Transportation Services/Safety
Workforce, Vocational Training & Independent Living
Contact
DONATE
6th Annual HWD Registration Form
STEP 1: Enter Your Information
I am a...
(Required)
Select one...
Parent/Guardian
Professional
Volunteer
Educator
Family
Other
Please tell us your role in our beautiful SNIMC community:
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Mailing Address
Apt/Suite
City
(Required)
State
(Required)
Choose State...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
(Required)
Contact Phone Number
(Required)
Number of individuals with special needs in household
(Required)
Please enter a number from
0
to
5
.
Child 1: Birth Year
(Required)
Please enter a number from
1924
to
2024
.
Child 1: Disability
(Required)
Select one...
Autism
Down Syndrome
Cerebral Palsy
Other / Multiple Disabilities
Please list Child 1's disability/disabilities.
Child 2: Birth Year
(Required)
Please enter a number from
1924
to
2024
.
Child 2: Disability
(Required)
Select one...
Autism
Down Syndrome
Cerebral Palsy
Other / Multiple Disabilities
Please list Child 2's disability/disabilities.
Child 3: Birth Year
(Required)
Please enter a number from
1924
to
2024
.
Child 3: Disability
(Required)
Select one...
Autism
Down Syndrome
Cerebral Palsy
Other / Multiple Disabilities
Please list Child 3's disability/disabilities.
Child 4: Birth Year
(Required)
Please enter a number from
1924
to
2024
.
Child 4: Disability
(Required)
Select one...
Autism
Down Syndrome
Cerebral Palsy
Other / Multiple Disabilities
Please list Child 4's disability/disabilities.
Child 5: Birth Year
(Required)
Please enter a number from
1924
to
2024
.
Child 5: Disability
(Required)
Select one...
Autism
Down Syndrome
Cerebral Palsy
Other / Multiple Disabilities
Please list Child 5's disability/disabilities.
Organization Type
(Required)
Choose one...
School / Academia / University
Agency
Nonprofit
Business
Government
Sponsor
Other
Name of Organization
(Required)
Organization Mailing Address
(Required)
Organization Mailing Address: line two
City
(Required)
State
(Required)
Choose State...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
(Required)
Job Title
(Required)
Name of School / Agency
(Required)
Mailing Address of School / Agency
(Required)
Apt/Suite
City
(Required)
State
(Required)
Choose State...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
(Required)
Volunteer Consent
(Required)
By checking this box, I confirm that I am at least 16 years old, or have received permission from my parent or guardian to volunteer with Special Needs In My City.
I agree.
How did you hear about us?
Choose one...
Friend
Family
School
Facebook
Instagram
Community Outreach
Search Engine
AI assistant
Other
We welcome you to SNIMC!
How can we help you?
How can we help your company/organization?
STEP 2: Select Tickets
Conference Tickets:
(Required)
Select your In-Person Ticket Tier...
Early Bird Special $39 (Sales end October 15th)
How many tickets?
(Required)
Please enter a number greater than or equal to
1
.
Total
STEP 3: Payment
Credit Card
(Required)
Card Details
Cardholder Name
About Us
Read Aloud
Events
Join us for November 2, 2024 Health & Wellness Conference
2023 | 5th Annual Health & Wellness
Parent Support Meetings
Calendar
Links
Parent Support Groups
Podcast
Blog
Community & Online Resources
Community Agencies and Programs
Day Programs/ Child Care
Deaf and Blind Services
Educational
Legal
Medical Facilites
Medical supply and loan closet services
Parent Support Groups
Recreational
Residential Group Homes
Sibling Issues/Special Needs Siblings
Transportation Services/Safety
Workforce, Vocational Training & Independent Living
Contact
DONATE