Jump to Content

Sign up for Center Mailings

The Center periodically offers free or low cost trainings for parents and professionals.

Information collected on this web page is gathered solely for the purpose of sending or e-mailing information from the Southeast Regional Center. Your contact information will not be shared with any outside persons or organizations.

This form will be submitted directly to the Regional Center; you do not need an e-mail address. If you have any problems, you may call (414) 266-NEED or toll free at (800) 234-KIDS to provide staff the following information.

What is your name? * First Last
Type your first and last name in. We'll send all correspondence to this person.
What is your e-mail address?

Please enter in your e-mail address. We'd like to contact you about interesting trainings and workshops provided by the center.
What is your phone number? - (###) - ### ####
Please enter your phone number, area code first.
What is your address?
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

If you'd like to receive US Postal mailings from us, please fill in your complete address.
How would you like to be contacted? * E-mail address US Postal Mail
If you live outside of the Continental US, we will only send updates via Email Both E-mail and US Postal Mail

Please select the most convenient method for us to contact you. We will use your e-mail address and street address entered on this form.
What is your main role? Parent CYSHCN Professional
We'd like to know if you are a parent or a Children and Youth with Special Health Care Needs(CYSHCN) Professional. If neither options describes you or you'd like to provide further information please fill in the 'Other' field.
Other

This is optional. Please provide us some details if you are neither a Parent or CYSHCN Professional.