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REUNITED VIDEO ORDER FORM
This video regarding ASFA is ONLY for parents entering the child welfare system largely due to meth related problems. This is not a pharmacology video or a drug lab video. This video is not for kids, police officers, preventionists or others not directly in contact with ASFA parents.
Where do you want us to send the video?
Name of agency_________________________________________________
Your Name ____________________________________________________
Address _______________________________________________________
______________________________________________________________
State_______________ Zipcode (5 digits)____________________
Phone: _____________________________________________
Do you want it on DVD or VHS Tape? (if you order it on DVD it will only play on a DVD player, it will not work on a CD player or on a computer’s CD Drive, it will work on your computer if your computer has a DVD drive built in, look on the front of the drive if you’re not sure. If it doesn’t say DVD on the front of the drive then it does not play DVD’s)
Check one of the following:
_________VHS Tape __________DVD
Make check or money order payable to Eric Martin, M.A., CADC III
Mail this form along with your check or money order for $21.95 to:
Eric Martin, M.A., CADC III
2054 N. Vancouver Ave.
Portland, Oregon 97227
Once the order is received, your video will be mailed within 72 hours!
Contact information:
Eric Martin, M.A., CADC III
Executive Director, Addiction Counselor Certification Board of Oregon
Instructor, University of Oregon and DHS Child Welfare
(503)231-8164
If you desire training in your area, please contact Eric Martin regarding the following 1-day courses (accredited by NAADAC, provider # 000182)
Ø Treating Marijuana Dependence
Ø Methamphetamine Addiction Treatment Best Practices and Child Welfare
These trainings have been presented in Oregon, Washington, Alaska, Montana, and Idaho