Membership Form

Name of Company : *                  
(headquarters):
This is how your information will appear in all association publications.
Street Address:                         
Suite Number:                            
City:                                              
State:                                            
Zip Code + 4:                               
Name of designated voting representative:.
Courtesy title (Mr./Ms./Mrs.): 
First name: *                                
Nickname:                                   
Last Name:                                 
Title:                                            
Phone: *                                        
Fax:                                              
Personal e-mail at company: * 
Company e-mail:                      
Company Web Site address:  

Desired Membership Classification:*
Regular Member Dues $500
Associate Member Dues $350
Pledged Government Affairs Contribution:  
  •      Direct placement companies recommended minimum contribution $1000 to $2500
  •      Contract staffing companies recommended minimum contribution $2500 to $4000
  •      Associate members are encouraged to contribute as much as they are financially able


Organizational Profile

How did you hear about AAIHR?
AAIHR member referral (please specify)

Web site
Other (please specify)

What is the primary nature of your organization?
US Based Recruiting or Staffing Company
Offshore Agent (subcontractor to US based Staffing Companies)
Healthcare Provider Organization (e.g., hospital, long-term care facility)
Regulatory or Credentialing Organization
Industry Vendor
Other

If you represent a recruiting or staffing company:

What international recruitment services do you provide?
Direct Placement Services
Contract Placement Services
Other (please specify)

What occupations do you recruit for?
Registered Nurses
Physicians
Allied Health Professionals (PT/OT/SLP/Pharmacy, etc)
Other (please specify)