Name
Title
Organization
Work Address
City
Zip Code
Work Telephone
Home Address
Zip Code
Home Telephone
Send Correspondence to: Education: _ PH.D _ MA _ BA/BS _ LSW _ CAC _ Other I have been in recovery: Since-Month Year Total
Time I am not in a recovery program
Yes No
PLEASE FILL OUT THE ABOVE
APPLICATION, PRINT IT, AND MAIL IT TO THE BELOW ADDRESS.
IF YOU DO NOT HAVE A
PRINTER, SEND WITH $52.00 (THE BELOW INFORMATION).
NAME; ADDRESS; COMPANY;
TELEPHONE; E-MAIL/FAX /URL (IF YOU HAVE ONE)
Membership: Free or $52.00 PER YEAR (This is a donation for
a Group membership.) Also includes member
compensation program. See membership benefits .
MAKE CHECKS TO:
VICTORY OVER ADDICTION
INTERNATIONAL, INC. (HOME)
Mail to:
VICTORY OVER ADDICTION INTERNATIONAL, INC.
5370 Merion Way
Stuart, Florida 34997
A Nonprofit Organization
*********************************************************************
For membership in VOA: (Victims Of Alcohol
)
Joining VOA as a Member: $52/Year Please enlist me in the fight against all alcohol related offenses and
tragedies.
This Membership automatically makes you a member of
Victory Over Addiction International, Inc. (A non-profit organization)
NAME___________________________________________________
ADDRESS________________________________________________
CITY_____________________ STATE_________ZIP_________
COUNTY__________________
HOME
PHONE________________Fax_____________E-Mail_____________
DONATIONS:
$25____$50____$100____Other______
Thank you
Please send application and all donations to:
Victory Over Addiction International, Inc.
5370 Merion Way
Stuart, FL 34997
Victory
Over Addiction International, Inc
voai@att.net
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