WADD Form

WADD Membership Registration Form

Membership fee: 25 euros/per year
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Area CodePhone Number
Organization/Hospital*
Degree*
If you are affiliated to some Local Psychiatric or Addiction Society in your Country, please type below

SUBSCRIPTION TO WADD

WADD membership

€25.00 for each year

WADD Membership Registration Form