INDIVIDUAL with more than one office location

AABA of Philadelphia Directory listing form

Overview of Listing Application Steps:

 

 TIPS:

  • Do not press your browser's back button during the application process or you will lose the information you have entered.
  • SCROLL down to each section (instead of tabbing down) to be sure that you do not miss a section.
  1. Fill in Parts One and Two below.
  2. When you have completed Part Two, you will be asked to check the “I AGREE” box and press “SUBMIT.” After you press “SUBMIT,” if all of the required information was entered correctly, you will see the “Success! Your form was sent” confirmation at the bottom of the page. If this “Success” confirmation does not appear, scroll back up through Parts One and Two, check off or enter any missing information, and then check off the “I AGREE” box and press “SUBMIT” again.
  3. Below the “Success! Your form was sent” confirmation, you will be instructed to click through to the Payment page where you will be able to pay online with PayPal.
  4. After your application and payment have been received and your information has been reviewed, your listing will be included in the AABA of Philadelphia Treatment Provider Online Directory for the one-year membership cycle (September 1 through August 31).

    

Information in Part One will be included in your Directory listing. Please be sure that your responses are accurate and recorded as you want them to appear in the Directory. No changes can be made to directory listings until next year’s renewal period (with the exception of changes in phone, address or e-mail).

 

(If this is a renewal and you do not want to make any changes to your listing, you do not have to reenter all of the information again. Just enter "same" in the boxes marked with an asterisk in Part One. Please then complete Part Two.) 

 

The confidential information in Part Two is for AABA of Philadelphia Board review only.  It will not be included in your Directory listing.

 

If you have questions or difficulty with this online form, please contact the Directory administrator at aabadirectory@gmail.com.

Note: Please fill out the fields marked with an asterisk.

AABA Directory of Providers