Membership Application: Individual

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Name*

Username

Display Name

Title/position

Country*

City*

Address*

ZIP/postal code*

Phone*

Fax

E-mail Address*

Website

Describe your drug related work

How can you contribute to the work of the WFAD?

In what ways can WFAD support your work?

Are you an individual?*

Yes

Attachments

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MEMBERSHIP AGREEMENT

As a member you agree to support and work toward the goals in the Constitution of WFAD. Membership may be terminated if your actions and activities are contrary to the objectives of WFAD or the WFAD by-laws or Constitution.

I agree

_{By submitting this application you consent that we store your information - you may unregister at any time.}

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