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P.O. Box 98371
Des Moines, WA 98198
253-273-4171
206-870-9079
WWW.NWADVTP.COM
Membership Form
Please note that all fields in Red are required

Contact Information

Name:

Agency Name:

Agency Address:

City:

State:

Zip Code:

Agency Phone:

Fax#:

E-Mail:

I hearby certify as an individual and agency that my intervention with offenders meets or exceeds WA state Laws (WAC 388-60) and complies with the NWADVTP Articles of Incorporation /By Laws.

Membership cycle - July 1st through June 30th

    

Please Click on the Next button after you have filled in all the information and then verify that the information is correct. Then print the application, using the Print Form Button. Please send this application and a copy of your WA State DSHS program approval to:
      NWADVTP
      PO Box 98371
      Des Moines, WA 98198
      253-273-4171 or 206-870-9079

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