Part 1: Company Information
Company Name
Member Number (if you have it from your renewal notice)
Primary Contact Name
Primary Contact's Email
Address
City
State/Province
Country
Zip
Phone
Fax
Website
Note: Fields in red are required values
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 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
  • Recieve 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 (1-5 employees) ($295) - All benefits in above overview plus:

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

Corporate (6+ employees) ($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 Corporate ($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 sites
  • 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

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

  • Regular Membership (1-5 employees) includes three (3) complimentary categories
  • Corporate Membership (6+ employees) includes eight (8) complimentary categories
  • Sustaining Membership includes unlimited complimentary category listings

    Additional category listings can be purchased for $15 per category.
Service Categories
Employer Alternative Specimen Testing Consortium/TPA
Collection Services DOT Physicals Employee Assistance Programs
Alcohol Testing Medical Review Officer Freelance Specimen Collection
Supervisor/Employee Training Certified BAT Testing 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 Q & A Services
Background Screening DNA Testing Laboratory
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
Promotional 50 Word 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
YES! Please print my listing in Bold Print.
Part 4: 2012-2013 Dues
2010-2011 Membership Dues Category Listings* 50 Word Description Bold Print Listing
Total
Regular (1-5 employees) $295 =
Corporate (6+ employees) $595 =
Sustaining $2300 no charge no charge no charge
Optional Additional DATIA focus Subscriptions
Annual Subscription - $48 =
TOTAL
*(regular includes 3 categories, corporate 8, sustaining unlimited)
Part 5: Payment Information
Payment Type:
MC VISA AMEX
Cardholder's Name
Card #
Exp. Date
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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


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