ADIS Class Registration

ADIS Class Registration Form

This form registers you for Gateway’s 8-hour Alcohol & Drug Information School (ADIS) class. The class runs from 8am to 4pm with regular breaks. We’ll contact you after submission to arrange your class materials and give you required information.
Important Information:

If you had your evaluation somewhere other than Gateway Counseling, please bring or send a copy of your assessment results to info@gatewaycounseling.net.
Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Do you have a legal deadline for completing this class?

MonthDayYear
Date
Preferred Class Date
Where did you have your evaluation completed?
How would you like to receive your class materials?
Acknowledgment Checkbox
Signature
Class Payment
prevnext( X )
ADIS CLASS
$115.00 Quantity

Total

$0.00
Should be Empty:

ADIS Class Registration Form