User Registration

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Create Account

Notice

Please enter your complete registration information. After you click Create Account, you will be prompted to return to the login screen so you can log in with the password you created.

Basic Info

First Name

Last Name

Full Name

* This is used on your certificate.

Email Address

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Password

* must contain at least 8 characters

Profile Image (Optional)

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User Profile

* indicates required field

Have you attended a Milestones Conference or workshop in the past?*

How did you hear about this event?*

Cell Phone*

Home Address Line 1 (ex: 25 Main St. Apt 2)*

Home City, State, and Zip Code (ex: Cleveland, OH 44143)*

Employer (If non-professional put N/A)*

Work Address Line 1 (ex: 6200 Commerce Park, Suite 1) If non-professional put N/A*

Work Address Line 2 (ex: Cleveland, OH 44107) If non-professional put N/A*

What is your identity? (Check all that apply)*

Administrator, Director

School Administrator, Director

Adult Services Provider

Aide, Paraprofessional, Tutor

Behavior Therapist, Consultant

Counselor

DD, Support Administrator, Case Manager

General Education Teacher

Individual with ASD

Nurse

Occupational Therapist

Parent of Individual with ASD

Other Relative of Individual with ASD (Check off "Other" below to give detail.)

Physical Therapist

Physician, PA

Psychologist

School Psychologist

Social Worker

Special Education Teacher/Intervention Specialist

Speech-Language Pathologist

Transition Coordinator

Other

What is your Gender Identity? We are committed to meeting the diverse needs of the autism community.*

What is your Race/Ethnicity? We are committed to meeting the diverse needs of the autism community.*

Please select your language

English