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. If you are court ordered to do ADIS, please provide us with a copy of your court order. You will need to come to Gateway Counseling in person before the class to pick up your class materials. If you live out of town or have other barriers that would prevent you from coming in person to pick up your materials, please call or email us.
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
Where did you have your evaluation completed?
Preferred Class Date
Acknowledgment Checkbox
Signature
Class Payment
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ADIS CLASS
$115.00 Quantity

Total

$0.00
Should be Empty:

ADIS Class Registration Form