Membership Application Form  
 
If you are an active recruiter and have been invited to become a Member by an existing member (your sponsor) we invite you to complete the Membership Application Form below.
  Sponsors Name: 
  Applicant's First Name: 
  Last Name: 
  Job Title:
  Company Name:
  Street Address:
  City:
  State:
  Zip Code:
  Email Address:
  Web Site Address:
 Business Phone:
 Fax Phone:
 Toll Free:
 What is your  firm's total number of offices  including your headquarters office:
 How many recruiters and support personal         (  project managers / researchers) are in your  company?
 Is your company a member of any other  associations and if so which ones?
 Best Time To Contact You:
 What is your desk Specialty?

  For example: Software: Sales, Sales Support,  Management and Marketing
 Please let us know why you wish to join  US-Recruiters.com. Also, please let us know  what you expect to gain from membership in  us-recruiters.com.

  Birth Date - Month and Day:
  Wedding Anniversary:
  Date & Year you became a recruiter:
  Date & Year - Business Anniversary:
  What MRI/SC office did you work in?:
  What was your mangers name?:
  What were the dates you were there?:
  Do you know an MRI Alumni we should talk to regarding joining USRC. Please provide name and contact information:
  Were you CSAM Certified - Yes or No
  Are you a CPC - Yes or No
  Please provides us the names, telephone numbers and email addresses of two recruiters (non-members) you have recently conducted splits with:

We will be calling your referecnes prior to the final approval as a member of The US Recruiters Network.

  Recruiter Number One: Name & Tele #
  Recruiter Number Two: Name & Tele #
 In the event a financial dispute involving a split with a member, I agree to resolve the dispute by bring my case to the US Recruiters Arbitration Board.
Yes     No
 I agree to promptly pay my Dues upon submitting this form
Yes     No

Electronic Signature (Your Full Name)
Todays Date: