Provider Network Membership

Please complete this application for new or renewed membership in the Empowered Recovery Provider Network.

• Please review the Provider Network Membership Dues Structure for details about each membership option. You will select your preferred membership after submitting this application.

• Please ensure you have selected the Provider Network Membership that best fits your organization. If your organization operates multiple facilities, additional client workbooks and facilitator guides may be purchased separately for each facility.

• Payment may be made securely by credit card, Venmo, or check. Access to your Provider Network Membership will be activated upon approval and receipt of payment.