New Massage Inspection Program Application (MIP)

Business Name * Required
Business Street Address * Required

**Please include suite or unit number
Number of Employees * Required
Contact Name * Required
First Last
Phone * Required
Contact Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email * Required
Copy of valid CMT Certificate * Required
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB.
Maximum file size - 50 mega bytes.
Copy of Valid Drivers License * Required
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB.
Maximum file size - 50 mega bytes.
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