ACTA Membership Application
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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

Name______________________________________________________________________
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Organization_________________________________________________________________
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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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Expiration Date:_________________________________
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New Member________________________________________
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JOIN THE ACT ASSOCIATION OR RENEW YOUR MEMBERSHIP TODAY AND SAVE ON FUTURE CONFERENCE REGISTRATION FEES