DATIA Update Membership Categories

Part 1: Company Information
Company Name
Primary Contact Name
Primary Contact's Email
Address
City
State
Zip
Phone
Fax
Website
I am a current DATIA Member
Part 2: Additional Categories for Industry Directory

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


Additional category listings can be purchased for $15 per category.
Service Categories
Alcohol Testing EAP On-Site Testing
Alternative Specimen Testing Laboratory Drug Free Policy Development
Consortium/TPA Medical Review Officer Substance Abuse Counseling/Treatment
Collection Services Mobile Collections Substance Abuse Professional
DOT Physicals Non-mandated Testing 24 Hour Availability
Student Drug Testing DNA Testing Background Screening
Freelance Specimen Collector QA Services Supervisor/Employee Training
Supplier Categories
Alcohol Testing Instruments Collection Supplies Drug Testing Supplies
Alcohol Testing Kits Periodicals On-Site Drug Testing Kits
Alcohol Testing Supplies Testing Software Training Supplies
Agencies and Modes
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
YES! Please print my listing in Bold Print.
Part 3: Totals
This is a correction of existing information (no new categories, new description or bolding)
This is a an addition of categories
Category Listings 50 Word Description Bold Print Listing
Total
=
TOTAL
Part 4: Payment Information
Payment Type:
MC VISA AMEX
Card #
Cardholder's Name
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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