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Suite 102 · 810 E. Grand River Ave · Brighton, MI 48116

810.227.1859 · Fax: 810.227.5785 · acta@actassociation.org

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ACTA Membership Application
Formatted For Printer format for printer
To become an ACTA member, please print this page; mail or fax the completed form along with your dues to the ACT Association as indicated on the form. Your paid membership will allow you to register for the conference at reduced rates, and provide support for the association to carry forth it's mission of promoting quality ACT services. Thank you.

ACTA
Assertive Community Treatment Association, Inc.
810 E. Grand River Ave., Suite 102
Brighton, Michigan 48116
P: (810) 227-1859
F: (810) 227-5785
acta@actassociation.org

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Organization_________________________________________________________________
Address____________________________________________________________________
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Annual Membership Fee:
Individual Members $35.00
Non-Profit Agency $150.00
For-Profit Agency $375.00
Make Checks Payable To:
ACT Association
810 E. Grand River Ave., Ste. 102
Brighton, MI 48116

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JOIN THE ACT ASSOCIATION OR RENEW YOUR MEMBERSHIP TODAY AND SAVE ON FUTURE CONFERENCE REGISTRATION FEES

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Assertive Community Treatment Association, Copyright © 2001-2007. All rights reserved.
Last Revised: Feb 04, 2008