International Council on Alcohol and Addictions

Conseil international sur les problèmes de l’ alcoolisme et des toxicomanies

ICAA Membership Application

Yes, I / we want to join ICAA - the International Council on Alcohol and Addictions, the network of all those concerned with preventing and reducing the harmful effects of the use of alcohol, tobacco, other drugs and addictive behaviours.

Membership Category

I / we would like to apply for membership in the following category (cf. description of different categories):

Gender

Title

First Name

Family Name

Institution / Organisation

Position

Postal Address (Street)

Postal Code

City

Country

Phone (international  line)

FAX (international  line)

Email

Alternative Email

Website


Major Fields of Interest (please check where appropriate)


Organisational Background (please check where appropriate)


Further Information (please check where appropriate and supply a copy)


Additional Comment