Register

When registering to participate in research at of Olga Tennison Autism Research Centre, the details you provide will be stored in our database salesforce.com with emails sent via our email marketing platform ExactTarget. Please click here to read Exact Target's Privacy Policy.

If you wish to have your details removed from our database, please contact otarc@latrobe.edu.au or 03 9479 3271.

Participant details

If you are a parent registering your child, please provide your child's details here.

First Name (Required):

Last Name (Required):

Date of Birth (Required):

Gender (Required):

Diagnosis - Please tick all applicable (Required):

 No Disability
 Autism Spectrum Disorder
 Autistic Disorder
 Asperger's Disorder/Syndrome
 PDD-NOS
 High Functioning Autism
 Other Disability (please specify):


Research participation

You can select one or both of the options below:

 I would like to register for the OTARC Research Participant Registry. I understand that my details will be included in the Registry and passed on to relevant researchers.

I would like to register for the following research studies. I understand that my details will be passed on to relevant researchers. (Enter the study code(s) for each study you are interested in, separated by a comma. Our current studies are listed below):

Studies currently recruiting participants

Contact details

Address (Required):

City / suburb (Required):

State (Required):

Post code (Required):

Country (Required):

Telephone (Required):

Mobile (Required):

Email (Required):

Declaration

 I am registering myself. I am over 18 years of age.


 I am the legal parent, guardian or carer of:

  • a child with an ASD and/or other disabilities
  • a child without disabilities
  • a person aged 18 years or older with an ASD and/or other disabilities

(Please provide your name)

Guardian Given Name:

Guardian Family Name:


More information

  I would like to receive further information from the Olga Tennison Autism Research Centre (e.g., quarterly e-Newsletter, Autism news alerts, news and information on upcoming seminars and workshops)

    

Print version Close