Payment - Marijuana Diversion Program - Council on Chemical Abuse

Please note: The non-refundable $50.00 service fee payable is required per referral to participate in the program. Service fee and signed referral must be submitted before the participant is eligible to schedule his/her class.

PAYMENT: Marijuana Diversion Program

Please Note: You do not need paypal to complete the payment. Once you are ready to pay, click the Paypal Button (not paypal credit) and then on the Paypal Screen choose Pay with Debit or Credit. Then, enter your email on the next screen, and on the final screen, before clicking Pay Now, make sure the Purchase Protection box is unchecked.

"*" indicates required fields

Billing Name*

Billing First Billing Last

Are you registering for yourself or someone else?*

Participant's Name*

Participant's First Initial Participant's Last Name

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

Does Participant need Spanish Translation (¿Necesita traducción al español?)

Yes (Sí)

Marijuana Diversion Program Payment*

Price:

Fee is non-refundable.

Payment Method

Having trouble with PayPal? If for one reason or another you're having trouble paying for this session, please email Laura at lcatalano@cocaberks.org, or call (484) 386-8669 ext. 122

Payment – Marijuana Diversion Program

PAYMENT: Marijuana Diversion Program