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Click ‘Get Form’ to open the application for membership in the editor.
Begin by entering your full name in the designated field (Last, First, Middle). This is essential for identification purposes.
Select your gender by checking the appropriate box. This information helps us understand our community better.
Fill in your present address, including street, city, state, and zip code. If applicable, check if you are currently at a treatment center or on probation/parole.
Provide your contact numbers: home and work. Ensure these are current so we can reach you easily.
Answer questions regarding your alcohol and drug use honestly. Indicate if you have a sponsor and how many meetings you attend weekly.
Complete sections about your income and any medical or mental health providers you may have. This information is crucial for assessing your needs.
Finally, review all entries for accuracy before signing and dating the application at the bottom of the form.

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