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Name

Do you have a learning disability or autism?

Yes, I have a learning disability or autism

No, I do not have a learning disability or autism

If you work for an organisation, please tell us the name here:

Please tell us your address. This can be your home or place of work.

What is your email address?

What is your phone number?

Would you like your details shared with any of our partner organisations? Tick all that apply.

Dates-n-Mates

Values Into Action Scotland

People First

C-Change Scotland

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