Individual Member Registration for New Jersey CARS

Individual Member Registration

You may fill out this form online below. Or you may download the PDF form and fax the completed form to 908-445-4025.

Username

Password

Confirm Password

First Name

Last Name

E-mail Address

Address

County

Zip

City

State

Phone Number

Demographic Information (Optional)

Gender

Race/Ethnicity

Age Range

18 to 30 years old31 to 50 years old

51 to 80 years old71 years old and above

Do you identify as (check all that apply in the dropdown when you click inside the box)

I am ...

Currently receiving/have received non-clinical, peer-driven recovery support servicesCurrently providing/have provided non-clinical, peer-driven recovery support services

A supporter of non-clinical, peer-driven recovery support servicesA professional in the mental health/substance abuse field

Other

If "Other", Please Explain:

Organizational Affiliation (Optional):

Job/Volunteer Title (Optional):

Licenses/Certifications/Trainings (If Applicable):

How did you hear about CARS?

Only fill in if you are not human