National Healthcare Staffing Alliance

If your Staffing Agency is a sub-unit of a larger orgainization, or if it is owned, operated, managed by, or affiliated with another organization, indicate the name and address of the organization.

What year was your firm established?

How many offices are in your firm?

How many states do you conduct business in?

Membership Level	Annual Dues*	If paid within 45 Days
1 to 5 offices (in no more than 5 states):	$500.00	Members who sign up with NHSA within 45 days of attending a membership meeting will be Considered "Founding Members" and their dues will be "locked in" for a minimum of 5 years
6 to 10 offices (in no more than 10 states):	$1,000.00
11 to 15 offices (in no more than 10 states): If in more than 10 states (dues are same as next line)	$3,000.00
16 to 20 offices (in no more than 15 states):	$6,000.00
Conducting business in more than15 states**: (This figure will be based on Company Revenues)	TDB***
*** - Assuming an industry average of a 25% gross profit margin, the formula for determining dues assessment for large national companies are as follows: Based on 2008 Published Revenues, calculate 25% margin of Gross Sales and assess a .001% membership fee. Paid Membership dues are valid for one year from the date of receipt and allows members to receive all of the services offered to NHSA members. All members agree to abide by the National Healthcare Staffing Alliance's Code of Ethics Statement as verified by signatory of said statement. Please contact NHSA if you have any questions.

* These fees are subject to change.
** Regardless of the number of offices in your organization