Table Talk Jr.

For Teens Ages 12-17

Get ready to meet and mingle with like-minded young teens (ages 12 - 17) on the spectrum. A great opportunity to be social and make new friends as you move from table to table to get to know new people. Table Talk Jr. is $25 and includes meal and a drink. TIME IS 4-6 PM. ARRIVE BY 3:30 FOR CHECK IN.

Space is limited for 16 participants

Brought to you by Life With the Spectrum with Gina Kavali on YouTube and Spectrum Autism Support Group.

Table Talk Jr. Registration (Ages 12-17)

(Maximum registrations 16 - No refunds for cancellations)

Participant Name*
First Last
Participants Age
Participant's phone number
Parent Name*
First Last
Phone
Please list your Email Address:*
Emergency Contact
First Last
Emergency Contact Phone
Are you gluten free?
- Yes
- No
List Any Other Dietary Restriction
Table Talk Registration
Price:
*After the event, we would like to follow up with you to find out how your experience was. Your input is extremely important and will help us plan future events. We would also like to provide names and phone numbers of individuals that you meet at Table talk that share common interests with you. Is it okay to share your phone number with another individual that you matched well with at Table Talk?
*After the event, we would like to follow up with you to find out how your experience was. Your input is extremely important and will help us plan future events. We would also like to provide names and phone numbers of individuals that you meet at Table talk that share common interests with you. Is it okay to share your phone number with another individual that you matched well with at Table Talk?
- Yes
By registering for this program I acknowledge that Spectrum Autism Support Group, Inc (Spectrum) and Gkasts has the right to photograph, videotape, and/or create other audiovisual materials of my participation in activities of Spectrum’s program Table Talk, and that Spectrum and Gkasts has the royalty-free rights to use the Audio-Visual Materials of participant in public relations, marketing and promotional activities and materials in any medium whatsoever including, but not limited to, videotapes, pamphlets, and brochures including use in print, radio, television, social media and the internet.