mlsa - Register for the mlsa

mlsa Agency Application Form

Register in 3 easy steps!

Please fill out the form below, and click "submit application"
Enter payment information (through PayPal)
Your login information will be emailed to you

If your agency is already a member; please click here to register additional users.

* Choose your subscription package:

Monthly Membership for $99/month

Yearly Membership for $1,080/Year
(Save 10% by selecting this option)

Fields that are required are marked with an asterisk (*).

1) Primary Contact Information:

*Company Name:

*First Name:

*Last Name:

*Title:

*E-mail:

*Phone:

*Fax:

Membership Information:

*Username:

*Password:

*Confirm Password:

*Address:

*City:

*State/Province:

*Country:

(USA/Canada only)

*Zip:

2) Agency Information

Same as primary contact address

*Address:

*City:

State:

*Country:

(USA/Canada only)

*Zip:

Corporate Website URL: http://

Year Business Started:

Type of Company:

State of Registration:

3) Indicate whether you are certified as any of the following:

Minority Owned Business

Ethnic Description:

Woman Owned Business

Disabled American Veteran Owned Business

Certifying Authority (required if completing this section)

4) What locations can you support? *

East North Central	Mid Atlantic	Mountain	New England	Pacific	South Atlantic	South Central	West North Central
All Chicago Illinois Indiana Michigan Milwaukee Wisconsin	All New Jersey New York New York City Pennsylvania Philadelphia	All Arizona Colorado Montana Nevada New Mexico Utah Wyoming	All Boston Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont	All Alaska California Hawaii Los Angeles Oregon San Diego San Francisco Seattle Washington	All Atlanta Delaware Florida Georgia Maryland North Carolina South Carolina Virginia Washington, D.C. West Virginia	All Alabama Arkansas Dallas/Ft Worth Houston Kansas Kentucky Louisiana Oklahoma Tennessee Texas	All Iowa Minnesota Missouri Nebraska North Dakota South Dakota

5) Please indicate your company’s capabilities to staff for the following industries *

Advertising/Marketing

Aerospace/Defense

Banking/Finance

Chemical/Process

Consumer Products

Energy/Utilities

Entertainment

Healthcare

Insurance

Legal

Non-Profit

Pharmaceutical/Biotechnology

Retail

Telecom

Travel

6) Please indicate your company's capabilities to staff for the following skill sets *

All
Accounting/Finance
Administrative/Clerical
Engineering
IT
Light Industiral
Sales
Scientific/Laboratory
Technical

7) What type of placements can you provide? *

Direct:

Temporary/Contingent:

8) Can you support Global Requirements?

Yes No

As an mlsa member agency, you must agree to the terms and conditions in the mlsa Member Agreement in their entirety.
Do you accept the terms and conditions of the mlsa Member Agreement? Yes No