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Please read and complete each part of this membership application.
Applications may be completed online, faxed, e-mailed, or
mailed U.S. Post.
Membership costs $63.00
Enrollment covers costs of random tests for enrolled persons,
regardless of the number of times each person is selected
from January 1, 2009 until December 31, 2009.
Once you fill out this form, you will be prompted
to pay for membership via PayPal.
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
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 $63.00
2009 Membership
Agreement
The Keys Consortium will provide each member: (a) A specimen
collection site near the applicant’s residence. (b) Computer
generated random selection of members. (c) Medical Review Officer
(MRO) services. (d) Drug free workplace policy. (e) Record keeping
of all positive test results for five years, and negative results
for one year. (f) Membership cards. (e) Referral service to
a local counselor and (f) a letter confirming compliance.
Member Responsibilities
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 address, phone number employer change
or membership status. (c) Follow all 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 to the terms of membership.
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