ONLINE APPLICATION Enrollment Application / Agreement ANNUAL MEMBERSHIP STARTING AT $125(Prices might vary depending on number of drivers)FOR A LIMITED TIME FREE Supervisor Training SUBMIT APPLICATION AND A REPRESENTATIVE WILL CONTACT YOU TO PROCEED WITH ENROLLMENT AND PAYMENT YOUR COMPANY INFORMATION INFORMATION: DRIVER (S) TO BE ENROLLED Date Of Birth CDL DriveUSCG Captain's LicenseHolderCrew MemberAviation ServiceNon-DOT Other Have you taken a drug and alcohol exam within the last 3 months. (required) YesNo Are you adding additional drivers (other than yourself) YesNo How Many? By clicking this box I/we understand that by joining this consortium and not refusing to be tested when selected, we meet the necessary requirements as listed in 46 CFR Parts 4, 5,16 & 49 CFR Part 40 & 14 CFR Part 120 for drug & alcohol testing for DHS, DOT, FMCSA, FTA, PHMSA & FAA. This program will place us in full compliance with federal drug testing laws. I/we understand that this membership does not include the Drug and Alcohol Clearinghouse. I/we further understand that continuous membership in the consortium will require an annual payment of the membership fee in addition to the charge that is in effect for testing and processing the sample whenever randomly selected. Current testing fees, as of this date, are $75 for Random Drug Tests and Alcohol Tests. All fees are subject to change. We further understand that we may request removal of our name from the consortium membership for any reason, at any time, by notifying USA Drug Testing Consortium Inc. or by not renewing our membership by the due date.