Add or Delete Captains or Crew from your Maritime Membership

If your company is not currently enrolled, please go to new membership application

Directions: Please read and complete each part of this form.

Applications with credit cards can be submitted online via secure server. Check payments must be sent regular mail.

If you are adding ANY crew members, you must comply with the DOT regulation concerning a background check.

"*" indicates required fields

Crew Members

Crewmembers to Add – Please enter Social Security Number with dashes

If you mark a crewmembers as exempt, you must provide us with a negative DOT test dated within the last 6 months or a letter of compliance, on Company letterhead, dated within the last 30 days. Please email to info@drugfreevessel.com

Add Crew Members That Need a Test
Name
Social Security
Date of Birth
Pre-Employment
License Status
 
Add Crew Members That Are Exempt
Name
Social Security
Date of Birth
Pre-Employment
License Status
 
Crewmembers to Delete
Click the + to add additional crew members
Name
Social Security or MID Number
 

Note: For every person you delete from your program, you can add one above for no enrollment fee

Note: Maritime ID Cards will be issued upon receipt of documentation of pre-employment status.

Membership Fee

(from above) $75 per person. $85 in AK, HI, PR, VI. For Saipan and Guam $100 per person. Does not include any discounts.
(from above)
$60 per test
$20 per kit (covers one captain/crewmember) (Mailed out within 2-3 weeks unless FEDEX is requested) See here for regulation
Shipping Method*
(Please specify Priority or Overnight shipping)

Payment Information

Payment Method*