YES, I WOULD LIKE TO JOIN THE NYC PLACEMENT CONSORTIUM.

Name: ____________________________

Title: _____________________________

Agency: ___________________________

Address: __________________________

__________________________________

City: _____________________________

State: _______ Zip: _________________

Telephone: ________________________

Fax: ______________________________

Please complete the above application and send the application to:

Arnold Dorin or Rachel Astalos
NYC Placement Consortium
C/O VESID
116 West 32 Street
New York, NY 10001