ELM Wings for Autism® Registration

Please complete this registration form for all individuals that will be participating in the Wings for AutismĀ® event on May 4, 2019 at Elmira Corning Regional Airport (ELM). Participants will be boarding the aircraft at 2:00pm, but we ask that you arrive at the airport by 1:00pm to allow ample time to check-in and pass through security. A small reception will follow participants de-boarding the aircraft.

All 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, each individual with a disability is allowed to attend with only one family member/support staff accompanying them to the event. 

If you have any questions or need assistance with completing this form, please contact Missy Goetschius at GoetschiusML@arcofchemung.org or 607-734-6151 ext. 122. 

First Participant
Full legal name (as it appears on a government-issued ID) of participant with disability:
Gender Identity *
Diagnosis of individual with disability: * 
T-shirts will be available for participants. Please provide your size. *
I consent to having my photo taken as part of this event. *