Online Membership

2017-18 Online Membership Form

It’s Easy To Join

1 ) Fill out Member Form below and “Press Submit Button”
2) Pay via PayPal

Note: If you only need to make a payment without filling out the form below, please click here

Membership costs $63.00

Directions

Please read and complete each part of this membership application. Applications may be completed online, faxed, e-mailed, or mailed U.S. Post (view contact information.)

Enrollment covers costs of random tests for enrolled persons, regardless of the number of times each person is selected from January 1, 2017 until December 31, 2017.

Memberships are from June to June.

Once you fill out this form, you will be prompted to pay for membership with a credit card via PayPal. Note: If you only need to make a payment without filling out the form below, please click here

A pre-employment drug screen is required for any person joining a drug testing program unless he/she has been tested within the past 6 months, or has been subject to random testing for at least 60 days within the past 6 months. If you are not required to take a pre-employment test, please enclose original documentation with application. If you need a drug screen we will provide you with a collection site in your area, please fill out the application accordingly.

If you currently need a test, it is an additional $60.00.

2017-18 Membership Agreement

The Keys Consortium will provide each member: (a) A specimen collection site near the applicant’s residence. (b) Computer generated random selection. (c) Random notification by email. (d) Medical Review Officer (MRO) services. (e) Drug free workplace policy. (f) Record keeping of all positive test results for five years, and negative results for one year. (g) Membership cards (please let us know if you would like this) (h) Information on substance abuse and counselor referral service. (i) Verification confirming program compliance for employers, licensing renewals, and upgrades.

New membership or Renewal of your membership shall be deemed as consenting to the following agreement. Members must (a) properly follow random testing instructions. (b) Promptly notify Keys Consortium of any change in mailing or email address, phone number, employer change, or membership status. (c) Follow guidance provided by Keys Consortium. Members shall not hold Keys Consortium liable arising out of or in connection with a member’s failure to comply with DOT policy or breech of this agreement. Failure to comply with provisions of this agreement will result in Coast Guard notification and possible termination from program.

To submit this form is to agree and acknowledge that I have read the membership agreement, that I fully understand that violation of this policy will be grounds for Coast Guard notification and possible termination of my membership.

Fields in red are required

PLEASE COMPLETE THE FORM USING UPPERCASE LETTERS

Five (5) digit zip code only
No spaces or characters. Example: 1234567890
Example: 06152016 mmddyyyy No characters
No spaces or characters. Example: 1234567890
No spaces or characters. Example: 1234567890
If you operate your own vessel please state if it is USCG Documented and/or State Registered and write the number.
If you need any DOT-approved alcohol tests, please email lori@keysconsortium.com
Sending