Want a great FREE way to promote your local business? Consider becoming one of the businesses who offer a discount to students through the NECASA Card. Print out this application and mail or fax it to us (see BELOW for contact info.) We will contact you to get you on the Website list ASAP!

____________________________________________ will participate in the
(Name of Business)

NECASA Substance Abuse Warning Card Campaign by giving students a discount

of ______% on purchases. This discount will be provided if student presents the NECASA card. Discounts will continue until September 1, 2006.

* Please note any special conditions associated with the discount.

I wish to extend this discount for the "College Card" (explained on cover letter).
Initials _________________

I do not wish to participate in the "College Card" program.
Initials _________________

_____________________________________________
Authorized Signature
Owner/Manager

Please return this form to: NECASA
559 Hartford Pike, Suite 210B
Dayville, CT 06241

Or you may fax the form to (860) 774-0827. If you have any questions please feel free to call Bonnie at (860) 779-9253.

PLEASE BE SURE TO INCLUDE YOUR BUSINESS ADDRESS AND PHONE NUMBER.

NECASA reserves the right to delist any business which NECASA feels is not providing the discount in students' interest.