New Member Application Organizational Info Membership dues are based on an organization's total (from all sources) annual substance abuse service budget. Membership begins at the time of first payment and is renewable after 12 months Payment options are available: Annual, Semi-Annual, Quarterly, Monthly. Your payment is calculated by dividing the annual dues amount by the appropriate number of payments and round the figure to the lowest whole dollar amount. Question Title * 1. Organization Information Voting Representative * Company * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Email Address * Phone Number * Question Title * 2. Please list any additional staff member who you would like us to include in our member distribution list Name Email Address Question Title * 3. Please indicate who at your organization should receive invoices related to ASAP dues payments. Name Email Address Next
