ATTI Registration
  1. First Name(*)
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  2. Last Name(*)
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  3. Email Address(*)
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  4. Street Address(*)
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  5. City(*)
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  6. State(*)
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  7. Zip Code(*)
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  8. Country(*)
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  9. Please upload documents in PDF, doc or docx (Microsoft Word) format. Documents larger than 5MB should be uploaded in a ZIP format. If you have some other document type, please create a ZIP file for upload. Images for drivers license should be jpg, png or in a ZIP file.
  10. Resume or CV
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  11. Diploma
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  12. Professional license or Certification
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  13. Driver’s license
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  14. Payment Information

    I agree to pay $_2,400_ for __160 hours of addiction therapy education provided by Dr. Carol L. Clark. I understand that this program is designed to meet the criteria as specified by the Florida Certification Board (FCB, provider#5094-A) and that all courses have been approved by the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, exp 3/17; Florida Board of Nursing, exp 10/17; Florida Board of Psychology, exp 5/18; Provider number 50-550/BAP585.

    I understand that completion of this program does not guarantee that I will be certified by FCB.  I will need to submit an application to FCB and pass the ICRC examination.

    I understand that if I choose to make monthly payments of $240.00, I am liable for payment in full by the final class in December 2017.  I understand that if I make payment in full, there will be no refunds if I do not complete the program.  I understand that there will be one make-up class that I will be able to attend if I have to miss a regularly scheduled class.

  15. Verification (*)
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