Certification Manual Order Form
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The GACA Certification Manual includes the application for certification as an addiction counselor through the Georgia Addiction Counselors Association. To request a copy of the manual, please print this page, fill the form out in its entirety and send with check or money order (fees paid by money order will be processed immediately) made payable to GACA (see bottom of form for fee rates) to: Georgia Addiction Counselors Association 4015 South Cobb Drive, Suite 160, Smyrna, Georgia 30080. Orders will not be processed until payment has been received.

CERTIFICATION MANUAL ORDER FORM

Responses are optional, but appreciated (please circle the most appropriate answer): I am currently working in the addiction field in:

Addiction Treatment     Education/Training    Administrative    As a Volunteer

Name

Address 

City   State   Zip    County

Home Phone  Work Phone e-mail

  GACA/NAADAC Member         $35.00                     Non-Member Rate         $70.00

Membership in the Georgia Addiction Counselors Association is a dual membership with NAADAC (GACA is the Georgia NAADAC Affiliate). To receive member discount, verification of membership must be provided if a new member within the last 4 weeks, i.e., copy of membership card or application & payment; date and method of phone application. For more information on becoming a member of GAGA/NAADAC please click here MEMBERSHIP.

Enclosed Please Find My Check or Money Order                        Please Charge My Credit Card $ (Visa or Mastercard only)

X (cardholders signature)                                                                                                                                           

 

(Please Print Name As It Appears On Card)  


   
Address Where Credit Card Bill is Received

Acct#___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Expiration Date on Card ___/___ VIN#___ ___ ___(last 3 digits on back of card)