Employer Application

The Mission of the MIBLN is to expand diversity in the workplace through the dynamic exchange of information among public and private businesses, community leaders, and job seekers with disabilities.

Company/Organization______________________________________________

Contact Person____________________________________________________
 
Email Address_____________________________________________________

Title______________________________________________________________

Address___________________________________________________________

Telephone_____________________________Fax_________________________

 
Additional Members (you may list up to 2 individuals to receive MIBLN information):
 
Name & Title ______________________________________________   
 
Email Address_____________________________________________
 
Name & Title ______________________________________________   
 
Email Address_____________________________________________

Company Website__________________________________________

 

As a partner, your company has access to the benefits of the MIBLN.  For a detailed listing of benefits link to www.mibln.org. 

Your MIBLN fee is determined by employee size in the State of Michigan:

Under 25 Employees……………...$100

26-100 Employees……………......$500   

101-500 Employees………………$1000

Over 500 Employees……………...$1500

 

 

Method of Payment   ____ Check Enclosed (made payable to MI BLN)

                                                                                         

                             ____ Please Invoice (include address if different from above)

 

                                                 

Please return application to:

MI BLN

32831 Bingham Lane

 Bingham Farms, MI  48025

 

For questions, submit to director@mibln.org