NBAC Memberships

The NBAC membership represents a cross section of the larger Black community, interested citizens, recovering alcoholics, counselors, administrators, politicians and business persons. In states where there are no chapters, an individual may apply directly to the National for membership.

All contributions to NBAC are deductible for income tax purposes.

Membership Application

Instructions: Enter your name as you want it to appear on your membership card. Enter the address where you want to receive your membership information.

* Required

	Prefix		Telephone Numbers:*
			Home Office
			Home Office
	First Name *		Agency/Organization

	Last Name *		Job Title

	Address *		E-mail Address


	City *		Website

	State *		Recommended By

	Zip *

Please Indicate Areas of Special Interest

	Administration	Rehabilitation
	Armed Services	Church
	Research & Evaluation	Community Services
	Training	Counseling
	Treatment	Education & Programs
	Occupational Prevention	Other

Educational Background Please List Certificates & Degrees

Special Skills Please Indicate Areas of Expertise in the Field of Alcoholism and Addictions

Please Indicate the Type of Membership You Would Like

	Regular $45
	Senior $25
	Student $25

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