Bermuda Employers' Council

Application for Membership

Please provide the following information

---

Name of Company:

Address:

Telephone:	Fax:	Email:

Number of Employees:

Name and Title of Contact Persons to Receive:

---

Confidential Information:	President:
Training Information:	Accounts Information:

Name of Authorised Person Submitting:

Title:

Date:Wednesday, September 9, 2010

Image Verification