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The undersigned hereby applies for membership in the Maryland Association of Professional Recruitment Consultants known as MAPRC.

Name of Organization:
Address:
City:
State:       Zip Code:
Phone:
      Ext.        Fax:

Name of All Owners, Partners and/or Corporate Officers:
  First: Last:
Title:
 
  First: Last:
Title:
 
  First: Last:
Title:
 
  First: Last:
Title:

Business Type:         Other:

State of Charter:      
Date of Formation:
Date of Incorporation (if appropriate):


List other offices not in the State of Maryland:

Any suits or legal actions outstanding:   yes no

If yes, explain:

Moreover, the undersigned certifies that he/she/they exclusively and solely engages in the business of procuring employees for "Employer Fee Paid" positions only and does not require any applicant to enter into any contract with the Member Firm as a condition of providing placement services to the applicant:
Date:
Name:

Name:

Name:

Name:


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