Northwest ATTC: Consent to be Contacted

As of September 30, 2017, the Region 10 Addiction Technology Transfer Center (ATTC) that serves those in the states of Alaska, Idaho, Oregon, and Washington will be undergoing a transition from the existing Northwest ATTC based at Oregon Health Sciences University to the new Northwest ATTC to be housed at the University of Washington Alcohol & Drug Abuse Institute

To enable the new Northwest ATTC staff to contact you in the future about ATTC-sponsored events and services, we are required to obtain your formal consent. 

Please complete the following personal information to assist Northwest ATTC staff in contacting you about future opportunities to participate in our events and services.

If you encounter any difficulties submitting this information, please contact Meg Brunner at the University of Washington Alcohol & Drug Abuse Institute at nwattc@adai.uw.edu or 206-543-0937.
I consent to be contacted by the new Northwest ATTC about future opportunities to participate in our events and services.

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* 1. I consent to be contacted by the new Northwest ATTC about future opportunities to participate in our events and services.

Full name:

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* 2. Full name:

Employer:

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* 3. Employer:

Street Address:

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* 4. Street Address:

City:

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* 5. City:

State

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* 6. State

Zip

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* 7. Zip

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* 8. Email:

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* 9. Please reenter your email: 

Preferred phone number:

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* 10. Preferred phone number:

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