PDF of Membership Application

Part 1: Company Information
Company Name
Primary Contact Name
Primary Contact's Email
Address
City
State/Province
Country
Zip
Phone
Fax
Website
Referred by
How did you hear about us?
I agree to abide by all Membership Rules
 Part 2: Membership Categories
Below, please find an outline of the benefits associated with each membership level. While you are to join at the minimum level based on the size of your organization, feel free to join at a higher level to take advantage of increased benefits.

 Member Benefits Overview

  • Receive quarterly DATIA focus Magazine
  • Receive bi-weekly DATIA eNews
  • Receive full access to information on datia.org
  • Are listed on the Searchable Internet Drug & Alcohol Testing Industry Directory and Buyers' Guide
  • Receive Washington Representation and regulatory alerts
  • Have full voting privileges on association matters
  • Have the opportunity to be elected to serve on the association's Board of Directors
  • Can attend DATIA networking events and legislative and regulatory briefings at member rates
  • Receive discounts on publications, annual conferences and training sessions

 Membership Categories (please choose one)

Regular ($295) - All benefits in above overview plus:
       *Must have no more than five employees to join at this level

  • Searchable Internet Drug & Alcohol Testing Industry Directory and Buyers' Guide Listing in a total of three categories

Corporate ($595) - All benefits in above overview plus:

  • Searchable Internet Drug & Alcohol Testing Industry Directory and Buyers' Guide Listing in a total of eight categories for up to five company locations
  • Ability to have up to five company representatives individually receive DATIA focus and other pertinent mailings
  • Opportunity to purchase a one-time use set of DATIA Membership Mailing Labels for use in marketing

Sustaining ($2300) - All benefits in above overview plus:

  • Searchable Internet Drug & Alcohol Testing Industry Directory and Buyers' Guide Listing in an unlimited number of categories for an unlimited number of company-owned and operated sites
  • Free bolding and free 50 word description in the online directory
  • Ability to have up to 10 company representatives individually receive DATIA focus and other pertinent mailings
  • Listing of company on DATIA letterhead
  • Prominent listing on the DATIA website with a link to company's website
  • One complimentary set of one-time use DATIA Membership Mailing Labels for use in marketing, and the opportunity to purchase additional sets
  • 20% discount on conference sponsorship with preferred booth location
  • One complimentary registration to the DATIA Annual Conference
Part 3: Promotional Categories for Industry Directory

Do Not List in Online Directory

Please check the categories under which you would like your company's listing to appear.

  • Regular Membership includes three (3) complimentary categories
  • Corporate Membership includes eight (8) complimentary categories
  • Sustaining Membership includes unlimited complimentary category listings

    Additional category listings can be purchased for $15 per category.
Employer
I am an EMPLOYER/COMPANY running an in-house drug and alcohol testing program for our safety-sensitive and/or other employees. Our company does not provide drug and alcohol testing services to clients.
Service Categories
Alternative Specimen Testing Consortium/TPA
Collection Services DOT Physicals Employee Assistance Programs
Alcohol Testing – BAT Medical Review Officer Freelance Specimen Collection
Supervisor/Employee Training Consulting
Mobile Collections Non-mandated Testing On-Site Testing
Drug-Free Policy Development Substance Abuse Counseling/Treatment Substance Abuse Professional
Student Drug Testing 24 Hour Availability QA Services
Background Screening DNA Testing Laboratory
Wellness Programs Franchise & Business Opportunities
Supplier Categories
Urine Specimen Collection Supplies Hair Drug Testing Supplies Oral Fluid Drug Testing Supplies
Drug Testing Laboratory - Urine Drug Testing Laboratory - Oral Fluids Drug Testing Laboratory - Hair
Breath Alcohol Testing Instruments/Supplies Oral Fluid Alcohol Testing Instruments/Supplies Point of Collection Drug Testing Kits
Drug and Alcohol Testing Software Training Supplies
Agency and Modes Tested
FAA FMCSA FRA FTA PHMSA USCG DOD DOE NASA NRC
Description Listing
Increase the effectiveness of your listing by including a 50-word description of your company's products and/or services. The description will be included in all categories under which your company appears. This feature is available for $50. This description is complimentary for Sustaining Members.
(No descriptions beyond 50 words will be accepted)
Bolding ($25 additional. Free for Sustaining Level Members)
YES! Please print my listing in Bold Print.
Prorated Dues
Prorated dues if joining other than in September. Directions: Select the month in which you are joining and see dues amount in membership category.
Month Jan Feb Mar Apr May June Jul Aug Sep Oct Nov Dec
Length 8 mo. 7 mo. 6 mo. 17 mo. 16 mo. 15 mo. 14 mo. 13 mo. 12 mo. 11 mo. 10 mo. 9 mo.
Regular $197 $172 $148 $418 $393 $369 $344 $320 $295 $270 $246 $221
Corporate $397 $347 $298 $843 $793 $744 $694 $645 $595 $545 $496 $446
Sustaining $1533 $1342 $1150 $3258 $3067 $2875 $2683 $2492 $2300 $2108 $1917 $1725
Note: The DATIA membership year runs from September 1 through September 1, therefore, dues may be prorated.
Part 4: Totals
Dues are Calculated on month joining, please select Current Month joining
Membership Dues Category Listings* 50 Word Description Bold Print Listing
Total
Regular $ =
Corporate $ =
Sustaining $ no charge no charge no charge
Optional Additional DATIA focus Subscriptions
Annual Subscription - $48 =
*(regular includes 3, corporate 8, sustaining unlimited)
Part 5: Optional Donations

How should your donation be recognized?

Note: DATIA will contact this person to inform them of your donation on their behalf.

Please accept my donation to the Diana Bauske Educational Scholarship Fund    
Please accept my donation to the Marijuana Outreach Education Fund                 
 Part 6: Payment Information
TOTAL
Payment Type:
MC VISA AMEX
Cardholder's Name
Card #
Exp. Date
Enter your promo code here.
Discounts based on your promo code will be applied before payment is processed.

Refund/Credit Policy:

DATIA membership dues and associate fees are non-refundable per DATIA’s By-Laws. Membership may be upgraded at any time for a prorated fee, based on the date of the upgrade and the current membership status. Please submit upgrade requests in writing to info@datia.org.

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This is a secure order form but if you prefer to print this out our Fax is: (202) 315-3579

For Check payments please print this out and send to:
DATIA • 1325 G Street, NW, Suite 500#5001 Washington, DC 20005