Apply Online

Send your application to MASAP by completing and submitting the form below.
Membership Level:	Full - based on agency operating budget Associate - $1200/year

First Name:
Last Name:
Title:
Agency Name:
Address:

City:
State:
Zip:
Phone:
Fax:
Email:
Website:

Annual Substance Abuse Budget:	Only Treatment Programs should enter budget information. Full membership dues are assessed based on total agency substance abuse budget. Associate member dues are $1200 and are not budget based.
Service Description:	If agency, please describe the services your agency provides in the field of substance abuse treatment and/or prevention.
Evidence of Collaboration:

List three (3) current MASAP members who will sponsor your membership application: One sponsor must be from your agency's primary geographic location.
Full Name:
Full Name:
Full Name: