ATTI Registration

    First Name(*)

    Last Name(*)

    Email Address(*)

    Street Address(*)



    Zip Code(*)


    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


    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 (*)