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Provider and Affiliate "Letter of Intent"

If you are interested and meet our Provider or Affiliate qualifications, please complete the "Letter of Intent" below and submit it along with your resume via fax or postal mail to:

FAX: (312) 558-1570

Perspectives, Ltd.
20 N. Clark Street Suite #2650
Chicago, Illinois 60602

Date:

Perspectives Ltd

Attn: National Affiliate Manager
  Provider Relations Manager

20 N. Clark Street Suite #2650
Chicago, Illinois 60602

To Whom It May Concern:

I would like to express my interest in being a:

EAP Affiliate

Network Provider

(Please Select Only One)

Attached is a copy of my resume

Sincerely,

Name:

Degree:

enc.