ATTI Registration First Name(*) Last Name(*) Email Address(*) Street Address(*) City(*) State(*) Zip Code(*) Country(*) Please upload documents in PDF, doc or docx(Microsoft Word) format. Documents larger than 5MB should be uploaded in a zip format. If you have some Other document type, please create a ZIP file for upload. Images for drivers license should be jpg, png or in a zip file Resume or CV Diploma Professional license or Certification Driver´s license Payment information I agree to pay $_2,4000_ for _160 hours of addiction therapy education provided by Dr. Carol L. Clark. I understand that this program is designed to meet the criteria as specified by the Florida Certificacion Board (FCB, provider#5094-A) and that all courses have been approved by the Florida Board of Clinical Social Work, Mariage and Family Therapy and Mental Health Counselling, exp3/17; Florida Board of Nursing, exp 10/17; Florida Board of Psychology, exp 5/16; Provider number 50-550/BAP585. I understand that completion of this program does not guarantee that i will be certified by FCB. I will need to submit an application to FCB and pass the ICRC examination. I understand that if i choose to make monthly payments of $240.00, I am liable for payment in full by the final class in December 2016. I understand that there will be one make-up class that i will be able to attend if i have to miss a regularly scheduled class. Verification (*)
