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Please fill out the form below and we will mail you dues structure and application. Username and password are used to log into the members section of the site. After application is approved, your user account will be activated. Thank You * Please note all fields are required Organization Information Organization Name Address City, State Illinois Alabama Alaska Arizona Arkansas California (Northern) California (Southern) Canada Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Phone Fax Website Contact Information Full Name Email *Username and password must be 6-10 characters Desired Username Desired Password

All rights reserved 2005
Illinois Alcoholism and Drug Dependence Association (IADDA)
937 South Second Street • Springfield, IL 62704
Phone: 217.528.7335 • FAX: 217.528.7340 • email: iadda@iadda.org