Drug and Alcohol Testing Industry Association
1325 G Street, NW, Suite 500#5001
Washington, DC 20005
800.355.1257 (p)
202.315.3579 (f)
datia.org
info@datia.org

Nationally Accredited for Administration of Drug and Alcohol Testing Programs Renewal Form

Step One: Please make any necessary changes to your contact information

Company

Contact Person

Address

City

State

Zip

Phone

Fax

Email

Company Website

Step Two: Please update your insurance information.

Professional Liability Insurance Expiration Date:

If we do not show that you have current professional liability coverage, please attach a copy of your current insurance certificate with this application.

Step Three: Please verify that you have attended the required 16 hours of continuing education over the past two years. Any course or education program that enhances your professional competency counts toward this continuing education requirement including DATIA Annual Conferences, meetings held by regional transportation agencies, chamber of commerce seminars, vendor product use education seminars, etc.

Years attended in DATIA Annual Conference:

DATIA courses taken over the last 3 years

Event Name

Event Name

Event Name

Date

Date

Date

Other Courses

Event Name

Location

Event Name

Location

Event Name

Location

Date

Length of Event

Date

Length of Event

Date

Length of Event

Step Four: Submit your NAADATP renewal fee.

Promo Code:
Enter your promo code here. Discounts based on your promo code
will be applied before payment is processed.

Total Due:

Payment Type:

VISA

Master Card

American Express

Card #

Name on Card

Expires

I attest that I and my company continue to adhere to the standards of the NAADATP program, and that I continue to uphold the highest standards in administration of my clients' drug and alcohol testing programs.