Membership Application

Online application is for new companies only. Existing companies please contact us directly to add an employee.

I want to enroll in the program online Click This Link

Before starting this online application, you will need to have available:

• The full social security numbers for all employees enrolling.

• If you have a recent drug test result (within 6 months) or membership in
another consortium, you should first upload proof of it to your computer
(If you don’t have one of these, it is not needed.)

• Credit card information

“Some browsers may not work with this link. If you have trouble, please use the paper application and scan or fax it to us.”

I want to enroll with a paper application form Click This Link