NAADAC Membership Fee Waiver Application

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* 1. Please enter your contact information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Are you currently employed?

Yes

If yes, please list employer and title/position.

If no, please list last day of employment and list former employer and title/position.

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* 3. Are you currently a NAADAC member?

Yes

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* 4. Have you ever been a NAADAC member?

Yes

If yes, please provide your member number and last year of membership.

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* 5. Why do you wish to become a NAADAC member or continue your NAADAC membership?

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* 6. Which membership level applies to you?

Professional

Associate

Peer Recovery Support Specialist

Student

Retired

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* 7. Which membership benefits do you intend to take advantage of?

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* 8. Do you intend on participating in any leadership opportunities or join any committees at the state or affiliate level?

Yes

If yes, please explain.

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* 9. Would you like information about how to get involved at your state or affiliate level?

Yes

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* 10. NAADAC offers many opportunities to volunteer. What contributions would you be willing to make?

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* 11. Please explain your need for financial aid for NAADAC membership.

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* 12. If needed, please attach any supporting documents here:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 13. Please share any additional information that you feel is necessary for us to know.

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* 14. I attest that all of the information contained in this application is true and accurate to the best of my knowledge. I understand that any misrepresentations I make in this application may constitute a violation of the NAADAC/NCC AP Code of Ethics and be grounds for revocation of NCC AP credentials, NAADAC membership, and/or other licensure and/or credentials.

I so attest.

I do not so attest.