Registration-Virtual (non-student) – Northern New England Society of Addiction Medicine

Name *

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Credentials *

Physician
Physician Assistant
Nurse Practitioner
Nurse (all other)
Social Worker(LSW)
Social Worker (LCSW)
Social Worker (All Other)
Certified Counselor
Pharmacist
Other (community member, administrator, journalist, etc. – please specify below)

Additional details

Email *

Are you an ASAM member?

NOTE: ASAM members qualify for member discounted registration fee.

Are you a NNESAM member?

NOTE: ASAM/NNESAM members qualify for member discounted registration fee.

City and State of Primary Professional Location *

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