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* Please use the survey below to register up to two individuals at your agency for the ASAM e-Modules. Registered individuals will be responsible for providing access to other agency staff as needed.

Staff registered from each agency will receive an email from the email address help@changecompanies.net with information on how to register with The Change Companies for access to the online training.

Please contact Rachel Stankowski (stankowski.rachel@marshfieldclinic.org) if your agency needs a copy of the ASAM Criteria, 3rd edition, 2013, to support local services.

1. Organization/Agency Name

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* 2. Please fill out information below for the key contact of your organization.

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* 3. a. List up to two individuals from your organization that you would like to participate and/or coordinate participation in the ASAM e-Training modules.

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* 3. b.

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