Page 84 - ccd-mag-fall-winter-2019

Membership Application

General Information
Company Join Date
Physical Address City State Zip
Billing Address City State Zip
Phone Website # Employees in CO Annual Volume $
Other Offices in Colorado
Company Name (if different from primary name)
Address City State Zip
Phone
Company Contacts Name Title Email Phone
Primary
HR/Training
Bus Dev/Mktg
Safety/Environ
Other
Accounts Payable Email

Membership Directory Information
Describe the type of work or service you provide to the construction industry. (200 characters or less)

Membership Classification
Are you a certified MWBE Firm? Yes No Are you an Emerging Business? Yes No (See description pg. 2)
Please check the box below that best describes your business.
General Contractor - As a general contractor, please indicate your firm’s project area(s):
Commercial/Institutional Civic/Municipal Industrial/Manufacturing Multi-Family Residential
Public Works/Infrastructure  Tenant Finish Single Family Residential
Specialty Contractor - As a specialty contractor, please enter the appropriate CSI code(s). (Refer to attached list.) You may list up to 5.
; ; ; ;
Associate Members
Professional Firm Supplier Government Entity
As a Professional Firm, please enter the service categories (attached) that best describe your specific area of service. You may list up to 5.
; ; ; ;
As a Supplier member, please enter the CSI codes or service categories that best describe your area of expertise. You may list up to 5.
; ; ; ;
Reasons for Joining AGC/C
Work Comp Program Safety Services Legislative Influence Networking Health Plan Education/Training
Discount Programs Other

How did you hear about AGC/C?
I am a former member Mailer Industry Reputation Broker AGC/C Staff Website/Email
Member: Who? Other

1114 W 7th Ave, Suite 200 Denver, CO 80204 (p) 303.388.2422 www.agccolorado.org

84 AGC Colorado Annual Magazine