Yes. I would like my business to become a member of the MHL Business Group Ltd. Upon acceptance, I will have the opportunity to take advantage of the dozen of the benefits and services that the Business Group offers.     

Please find enclosed my annual membership fee of $40 which covers me and all my employees.

My annual membership fee will be waived as I am a member of     Association and the annual dues I pay the Association covers my membership with MHL Group.

               ** Number of persons employed by my business:

     INCOMPLETE APPLICATION WILL RESULT IN DELAY OF PROCESSING FOR BENEFITS.

AGENT'S NAME:    PHONE:
AGENCY NAME:   
AGENCY ADDRESS:
AGENT SIGNATURE:     DATE:    

COMPANY CONTACT:  PHONE:   
COMPANY NAME: 
COMPANY ADDRESS:
COMPANY SIGN:        DATE: