Wings for Autism® Waitlist

Please complete this form to be placed on the WAITLIST for all individuals that will be participating in the Wings for AutismĀ® event on November 4, 2017 at Appleton International Airport (ATW). Participants will be boarding the aircraft at 9:10 AM, but we ask that you arrive at the airport by 7:30 AM to allow ample time to check-in and pass through security. Individuals 18 years old and over are required to bring a valid form of government-issued ID to be allowed through security.

Due to limited space, individuals with disabilities are allowed to have only one family member/support staff accompany them onto the airplane. However, up to five additional family members/support staff are welcome to attend the other portions of the event; they will just not be permitted to board the plane. All family members/support staff attending the event must provide the required information in the form below in order to obtain access into the airport.

T-shirts will be provided for participants with disabilities and the one family member that will be boarding the plane with the participant.  

If you have any questions or need assistance with completing this form, please contact Pla Yang at pyang@atwairport.com or 920-832-5267.

First Participant
Full legal name (as it appears on a government-issued ID) of participant with disability:

Gender Identity *
calendar
Diagnosis of individual with disability: * 
 
Some Wings for Autism events may have t-shirts available. Please provide your size. *
 
I consent to having my photo taken as part of this event. *