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Wisconsin Batterers Treatment Providers Association Membership Application
This application and checklist are for individuals or agencies who are prospective members. (This application and checklist are also required if membership has lapsed.) Please submit the completed application and the completed checklist by mail to: End Domestic Abuse Wisconsin, Attn: WBTPA, 1245 E. Washington Avenue, Suite 150, Madison, WI 53703.
You have the option of filling out either the Initial Application or a Renewal Application.
This application should be filled out for prospecting WBTPA members who are applying for their first membership or if there has been a lapse in time since their last WBTPA membership.
This application should be filled out by WBTPA members who have maintained their provider status without any time lapse in membership. (Note: Renewal applications will be emailed to current members before the end of the membership year (which runs from May 1 - April 30).
If your application is approved for membership, your name, batterers’ treatment program name, and your office contact information will be available on the WBTPA Listing Directory unless you indicate NOT to do so by checking the boxes in the application. The membership year runs from May 1st – April 30th. This application is valid for the May 1st, 2015 – April 30th 2016 WBTPA membership year.
When you have updated that information, please fill out our application and email it to firstname.lastname@example.org. You can also scan your proof of CEUs and email them in along with your application.
If you do not wish to fill out your application online, you can print it and either email the scanned version to email@example.com or mail it to:
End Domestic Abuse Wisconsin
1245 E Washington Ave, Suite 150
Madison, WI 53703
Please print off the WBTPA Payment Form, fill it out, and send it with your check to the address listed above. Checks should be written out to End Domestic Abuse WI.
Don't forget anything! Send your application along with a copy of your curriculum and membership checklist and payment form to firstname.lastname@example.org or mail it to the address above.