[   ]  Yes, I am interested in receiving additional information including exclusions, limitations, rates, eligibility and renewal provisions on Hospital Indemnity Insurance* from the AVMA GHLIT.

I am also interested in receiving information on the following GHLIT plans:

*Underwritten by New York Life Insurance Company (NY, NY 10010) on Group Policy G-14884/14885/14886/Face Policy Form GMR.

**Indicates required field

SmartBrief Hosp Ind 11-13