Don't Delay!   Take Positive Preventative Action Today...

Please send me _____ copies of the "Wrongful Termination" video at $150 each. (Price includes shipping and handling.)  I have enclosed a check, payable to MHRRG, for $___________.

______________________________________
Name/Title

______________________________________
Organization

______________________________________
Address

______________________________________
City/State

______________________________________
Zip

Telephone (______) ______________________

Best time to call: [  ] a.m.     [  ] p.m.

Yes! I want to learn more about the Mental Health Risk Retention Group.

[  ] Send me more information.  [   ] Have a representative contact me.

Is your organization a member of:

[  ] National Council for Community Behavioral Healthcare

[  ] Mental Health Corporations of America