SAAS Membership Form - 2014
Please complete this form with all required information and click "Submit" when complete.  

Call the office at 202-546-4600 or email Sarah, shansen@saasnet.org, with questions.
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Association Information
Name of Association
Contact Person First Name *
Contact Person Last Name *
Contact Person Title *
Address *
Address 2
City *
State *
Zip *
Telephone *
Fax
Email *
Web Address
Membership Categories
Please select the type of membership most appropriate for your organization/association.
State Associations (dues based on agency budget)
A State Association Member shall be defined  as any statewide alcohol and drug treatment and prevention association. State Association Members  have voting rights. A designated individual represents the association on the SAAS Board of Directors.
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Associate Member ($2,500)
An Associate Member is defined as a professional corporation that  provides professional services to SAAS’ addiction treatment provider members. Associate Members  can include but are not limited to technical assistance corporations, legal services, pharmaceutical  companies, drug testing organizations, employee training and services companies and publishers.  Associate Members have the same rights and privileges of membership with the exception of voting.
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Individual Organization ($500)
An Individual Addiction Treatment Provider Organization is defined  as any organization that is licensed to provide addiction treatment services by the state where the  organization resides; or any prevention or recovery organization that is contracted to provide said  services by the state in which they reside. Individual Addiction Provider Members have the same rights  and privileges of membership with the exception of voting.
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How would you like to pay? *
Please mail your check or call SAAS with your credit card information.
Association Profile
ALL membership categories should complete
Please indicate Status *
What other national association membership organizations do you belong to? *
Required
Are you interested in serving on a SAAS committee? *
Check all that apply (this does not obligate you and we appreciate your interest)
Required
We produce formatted e-newsletters specifically designed for you and your members! *
-- SAAS Update (newsletter)  -- SAAS Flash (news that can’t wait)  -- SAAS Opportunities for Learning (webinars, etc.)  
Required
We will include up to two other designated contacts on email communications (administrative assistant, board president, etc.).  Please enter their name and contact information below.
Include Name, Title, Phone and Email for each request.
Additional Information
Required for State Association Members
Total Number of Association Members?
Does your state use Medicaid to fund addiction services beyond the mandated pregnant women and adolescents?
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The Addiction Counselors in your state are
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