Lasact Membership Form PDF Details

The Louisiana Association of Substance Abuse Counselors and Trainers, Inc. (LASACT) extends a cordial invitation for membership through their comprehensive Membership Application. Catering to both new and existing members, including a special rate and form for students, LASACT aims to assemble professionals and students from the field of substance abuse counseling and training within Louisiana. Membership options not only offer a pathway to a vibrant community but also provide essential credentials and certifications that are recognized in the industry. The form, available for download on LASACT's official website, requires basic personal and contact information, alongside specifics regarding the applicant's credentials such as LAC, CAC, RAC among others, and any LASACT certificates held. Applicants have the flexibility to choose their payment method for dues, which supports their membership from January to December. This process ensures that members have access to resources, networks, and opportunities that are integral for professional growth and certification maintenance in the substance abuse counseling field. Whether through online payment, traditional mail, or over the phone, LASACT has streamlined its application process to be as inclusive and accessible as possible, making it convenient for professionals and students alike to be part of their community.

QuestionAnswer
Form NameLasact Membership Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesapplication lact download, application lact online, lasact renewal, membership application lact

Form Preview Example

Louisiana Association of

Substance Abuse Counselors and Trainers, Inc. (LASACT)

P.O. Box 80235 • Baton Rouge, LA 70898-0235 • Phone: 225.766.2992

Fax 225.766.8552 • e-m ail: adm in@ lasact.org • w eb site: w w w .lasact.org

MEMBERSHIP APPLICATION - LACT STUDENTS

G new membership G renewal of current membership

 

G reinstatement ($25 fee)

 

 

 

 

 

 

 

 

 

 

 

NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mr. Mrs.

 

Ms.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Title

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

 

Middle

MAILING ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

 

 

 

 

City

 

 

State

 

ZIP

EMPLOYER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

 

ZIP

PHONES: O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX

 

 

 

 

 

CELL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-MAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*************************************

 

 

 

 

 

 

 

 

 

ADRA Credential(s) - Check all that apply

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAC

 

CAC

RAC

 

CIT #

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LPP

 

CPP

RPP

 

PSIT#

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CCS #

 

 

 

 

Expiration Date

 

 

 

 

CCGC #

 

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATA #

 

 

 

 

 

 

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LASACT Certificate(s) Check all that apply:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AADC #

 

 

 

 

 

 

Expiration Date

 

 

 

CCDP-D #

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CCDP #

 

 

 

 

 

 

Expiration Date

 

 

 

 

 

CCJP #

 

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Types of Right to Practice Credential(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LPC #

 

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

LMFT #

 

Expiration Date

 

 

 

 

 

LCSW #

 

 

Expiration Date

 

 

 

 

 

 

 

 

 

LMSW #

 

Expiration Date

 

 

 

 

 

If credential is not in above list(s), fill in type / number / expiration date here:

Dues cover calendar year - January through December

Individual M embership $90.00 Ë Student M embership: $45.00 - Download student form at www.lasact.org

Full tim e student status m ust be verified - m axim um for student m em bership is two years.

Dues payment Options:

TOnline at www.lasact.org using PayPal and faxing application form to 225.766.8552

TBy check or money order sent through U.S. mail to: LASACT – P.O. Box 80235 – Baton Rouge, LA 70898-0235

TBy filling in the Credit Card information requested below and mailing to the above address or faxing to 225.766.8552.

TBy phoning Credit Card information to 225.766.2992 and faxing this form to 225.766.8552

Membership Applications - new or renewal - cannot be processed until

LASACT receives this Form.

***********************************************************************************

Credit Card information: Credit Card Type & #:

 

Expiration Date:

Security Code on back of card

Billing ZIP Code

Rev: November 8, 2011

How to Edit Lasact Membership Form Online for Free

When you intend to fill out lact form, you won't have to download any software - simply use our PDF tool. FormsPal team is constantly working to enhance the editor and help it become even easier for users with its extensive functions. Bring your experience to a higher level with continually growing and exciting options available today! It merely requires a couple of basic steps:

Step 1: Just press the "Get Form Button" above on this page to get into our pdf editor. This way, you'll find everything that is needed to fill out your document.

Step 2: When you open the PDF editor, you'll notice the document ready to be filled out. Besides filling out different blanks, it's also possible to do other things with the Document, such as writing custom words, modifying the initial text, inserting images, signing the document, and a lot more.

Be attentive when filling out this document. Ensure that all necessary areas are filled out accurately.

1. Whenever filling in the lact form, make sure to incorporate all of the essential blanks in the relevant form section. This will help to speed up the work, making it possible for your details to be processed fast and properly.

Simple tips to fill out application lact printable portion 1

2. The next step would be to fill out these particular blank fields: Dues cover calendar year January, Individual M embership Ë Student, Full tim e student status m ust be, Dues payment Options T Online at, T By phoning Credit Card, Membership Applications new or, LASACT receives this Form, Credit Card information Credit, Billing ZIP Code, and Rev November.

Completing section 2 of application lact printable

It's easy to make errors while filling in the Membership Applications new or, and so you'll want to take a second look prior to when you submit it.

Step 3: When you've glanced through the information in the document, press "Done" to conclude your FormsPal process. After registering afree trial account with us, you will be able to download lact form or email it immediately. The file will also be readily available through your personal cabinet with your changes. FormsPal is focused on the confidentiality of our users; we ensure that all personal information put into our tool stays protected.

Lasact Membership Form isn’t the one you’re looking for?

Related Documents