The Register of Addiction Specialists

Update RAS Information

Instructions:
Update your RAS information via e-mail by completely filling out the form below and pressing the "Submit Form button ". Please note that fields with an asterisk (*) next to them are required fields.

* First Name:
* Last Name:
  Phone Number:
* Address One:
  Address Two:
* Last 4 SSN Digits:
* E-mail Address:
If you have a picture of yourself on your computer, you can upload it by selecting the "Browse" button. Or you may send us your picture via email (college@breining.edu) or postal mail at a later time.
Profile Picture:
  Comments:
 

 

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