MFG Membership Application

MFG Membership Application

Thank you for choosing to be a member of the VMA. Please fill out the information below. A staff member will be in contact with you within 48 hours to answer questions and begin the on-boarding process. Welcome to the team!
Company Name:*
First Name: *
Last Name: *
Title:
E-mail:*
Cell Phone:*
Office Phone (including extension):*
Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Brief Description of Business and Products:

Insurance, Training & Employee Benefit Programs (Select here):
Property & Casualty InsuranceTraining and Workforce Credentials for my EmployeesGroup Employees Insurance401(k) Plan OptionsHR ServicesOther
As a member, you have exclusive access to our Insurance Services Program. New members receive a free review of your Business Property& Casualty coverages and Employee Group Benefits. Upload a copy of either yourpolicies or most recent billing statements here or send to Chase Barnett (cbarnett@va-mfg.com) to take advantage now.

Browse Files
Upload one or more files as needed. Cancelof

Professional development & other Member Benefits (Select here):
VMA ConferencesRegional EventsNetworking OpportunitiesFree VMA WebinarsMember DiscountsOther

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Company Contacts*
Annual Investment Amount Calculation

The VMA MFG Membership Annual Investment Rate is calculated based on the number of Full Time Equivalent Employees and Capital Investment.

Note: 2 Part Time Employees or 1 Full Time Contractor = 1 Full Time Equivalent Employee