Maine Association of Substance Abuse Program  
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MASAP Membership Application
You may send your application details to MASAP by completing and submitting the form below.

Membership Level:

Full - based on operating budget    

Associate - $500/year
Learn more about MASAP Membership Levels (pdf)
First Name:
Last Name:
Title:
Agency Name:
Address:
 
City:
State:
Zip:
Phone:
Fax:
Email:
Website:
Annual Substance Abuse Budget:


Only Treatment Progams should enter budget information. 

Full membership dues are assessed based on total Substance Abuse Operating Budget.
Associate member dues are $500 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: