Mid-America Association of Personnel & Staffing Services

2007 MAPSS Application for Membership
First Name:		Last Name:
Roles:	Owner Manager
Certifications:	Check all that apply: CPC CTS TSC CSP
Birthday:	Day:
Email Address:
Firm Name:
Address 1:
Address 2:
City:		State:	Zip:
Phone:		Fax:
Web Address:
Specialty:
Concentration:	Check all that apply: Temporary Direct Hire Contract
Membership Type:	Individual ($200) Corporate ($200 + $100 for each additional office with a cap of $2000) Affiliate ($400)

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