NJAMHAA Information Technology Council Application
By joining the NJAMHAA Technology Council, you will have direct access to our members – 160 nonprofit mental health, substance use, developmental disability, residential and human service agencies throughout New Jersey that treat individuals of all ages with mental illnesses, substance use disorders, developmental disabilities and co-occurring disorders. In addition, for more than 30 years, NJAMHAA has been in partnership with the N.J. State Division of Mental Health and Addiction Services through the NJAMHAA Information Technology Project. The NJAMHAA Information Technology Council will enable your company to share information and network with the agencies that are providing mental healthcare and substance abuse treatment services in New Jersey.

Please provide NJAMHAA with the following information:

Name *
Your answer
Title *
Your answer
Company Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Fax Number
Your answer
E-mail Address *
Your answer
Company Web Site *
Your answer
Number of Employees *
Your answer
Number of Agency/Organizational Contracts (nationally) *
Your answer
Number of Agency/Organizational Contracts (in New Jersey) *
Your answer
Annual Company Revenue *
Your answer
Please e-mail a copy of last year's annual report to jnoto@njamhaa.org.
Please e-mail a copy of last quarter's audited financial statements to jnoto@njamhaa.org.
Please e-mail a brief description of the product(s) and/or service(s) provided by the company or a company brochure to jnoto@njamhaa.org.
Dues must be paid with submission of application; otherwise, membership will not be activated.
Thank you for your application and payment!

The fiscal year 2017 fee for membership in the NJAMHAA Technology Council is $1,265. Please enclose your check with this application and mail to NJAMHAA, 3635 Quakerbridge Rd., Suite 35, Mercerville, NJ 08619.

If you have any questions or need additional information, please call June Noto at (609) 838-5488, ext. 202 or
e-mail her at jnoto@njamhaa.org.

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