Register Online for 5 Hour Problem Gambling Treatment :: ONLINE

Please complete the following secure page that will process your payment information.

NOTE: Please ensure that your address above is the BILLING ADDRESS for the credit card that you will enter below.
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By clicking the button below and submitting payment information you are entering into an agreement with us and understand that payment in full will be made from the credit card account you entered above in the amount of:

$25.00 (NYS Resident)
$40.00 (Non-Resident)