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LASACT Membership
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$
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LASACT • P.O. Box 80235 • Baton Rouge, LA 70898-0235
(225) 766-2992
• Fax (225) 766-8552 •
admin@lasact.org
•
lasact.net
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Dues cover calendar year - January through December. Convenience fee of $5 is added to all credit card and PayPal payments. Membership Application and International Certificates CANNOT be processed until LASACT has received payment and this form.
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Washington
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Wisconsin
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Armed Forces Americas
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Armed Forces Pacific
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ADRA and LASACT Credentials
Please check all items that apply to you in the section below. Fill in the appropriate information regarding credential numbers and expiration date.
ADRA Credentials
LAC
CAC
RAC
CIT
LPP
CPP
RPP
PSIT
CCS
CCGC
ATA
Other Credentials
LPC
LMFT
LCSW
LMSW
LASACT Certificates
AADC
CCJP
CCDP-D
CCDP
PRSS
SAP
LAC No.
LAC Expiration Date
Date Format: MM slash DD slash YYYY
CAC No.
CAC Expiration Date
Date Format: MM slash DD slash YYYY
RAC No.
RAC Expiration Date
Date Format: MM slash DD slash YYYY
CIT No.
CIT Expiration Date
Date Format: MM slash DD slash YYYY
LPP No.
LPP Expiration Date
Date Format: MM slash DD slash YYYY
CPP No.
CPP Expiration Date
Date Format: MM slash DD slash YYYY
RPP No.
RPP Expiration Date
Date Format: MM slash DD slash YYYY
PSIT No.
PSIT Expiration Date
Date Format: MM slash DD slash YYYY
CCS No.
CCS Expiration Date
Date Format: MM slash DD slash YYYY
CCGC No.
CCGC Expiration Date
Date Format: MM slash DD slash YYYY
ATA No.
ATA Expiration Date
Date Format: MM slash DD slash YYYY
LPC No.
LPC Expiration Date
Date Format: MM slash DD slash YYYY
LMFT No.
LMFT Expiration Date
Date Format: MM slash DD slash YYYY
LCSW No.
LCSW Expiration Date
Date Format: MM slash DD slash YYYY
LMSW No.
LMSW Expiration Date
Date Format: MM slash DD slash YYYY
AADC No.
AADC Expiration Date
Date Format: MM slash DD slash YYYY
CCJP No.
CCJP Expiration Date
Date Format: MM slash DD slash YYYY
CCDP-D No.
CCDP-D Expiration Date
Date Format: MM slash DD slash YYYY
CCDP No.
CCDP Expiration Date
Date Format: MM slash DD slash YYYY
PRSS No.
PRSS Expiration Date
Date Format: MM slash DD slash YYYY
SAP No.
SAP Expiration Date
Date Format: MM slash DD slash YYYY
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