Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.123ASSOCIATE MEMBER APPLICATION Use this application if your company is a: Subcontractor Supplier Architect / Engineer Accountant / Banker / Financial Professional Bonding Agent / Insurance Agent Other MEMBER INFORMATION Company Name:Mailing Address:Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhysical Address:Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOffice Phone:Primary Contact Cell:Website:Indicate the Social Media Platforms Your Company Uses:FacebookInstagramLinkedInPrincipal (Primary) Contact Person receiving West Texas AGC Chapter Notifications:This person will be listed as the contact for your company on our website directory, AGC of America database and yearly printed directory. They will be who we contact to authorize any changes requested by your company. Primary Contact Email: Accounting Contact Person:Accounting or Accounts Payable Email: Company Members who Should Receive Daily Update/Newsletters:Company Members who Should Have Internet Plan Room (cProject) Access: (Only For Subcontractors/Suppliers)Company Members who Should Have Continuing Education/Professional Development, Human Resources, Leadership, Safety, and/or Workforce Development Information:Company Members who Should Have Discount and Savings Program Information: # Years Minimum Next COMPANY BACKGROUND Date Company Established Under This Name:Has Your Company Been an AGC Member Before: YesNo# of Person in the Firm:If Yes, List Year and Under What Name and Chapter:Of These: # of Field Employees:Indicate if Your Company Is:SBE (Small Business Enterprise)WBE (Women-Owned Business)MBE (Minority Business Enterprise)LBE (Large Business Enterprise) Classification or Scope of Work Primary:CSI/UCI Code:Alternate:CSI/UCI Code:Alternate: CSI/UCI Code:Your Company is:CorporationLLCPartnershipSole Proprietorship Principal Officers Name:Title:# of Years With Company:Name:Title:# of Years With Company:Name:Title: # of Years With Company INSURANCE COVERAGE General LiabilityYesNoAgency:Agent Name:Agent Phone/Email:Workers CompensationYesNoAgency: Agent Name:Agent Phone/Email: REFERENCES (Provide a Minimum of 3 References in the Commercial Construction Industry) Company Name:Reference Type:Business/ProfessionalCustomerContact Person:Contact Phone/Email:Company Name:Reference Type:Business/ProfessionalCustomerContact Person:Contact Phone & Email: Company Name:Reference Type: Business/ProfessionalCustomerContact Person:Contact Phone & Email: Company Name:Reference Type:Business/ProfessionalCustomerContact Person: Contact Phone & Email: COMPANY LOGO Upload Logo Here: Drag & Drop Files, Choose Files to Upload Please upload a high-res version of your company's most up to date logo. We will use this logo in our website directory and when we reference your company in any social media posts. Upload the in following file formats: .jpg .jpeg .png or .pdf. NextUpdating preview…This is a preview of your application. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes. Acknowledgements/Membership Dues for West Texas AGC Agreement for Membership *I agreeBy checking this box, I understand that membership with the West Texas AGC also includes membership and affiliation with AGC of America and AGC-TBB (Texas Building Branch). Benefits, dividends and access to programs is included with the quarterly/annual dues. The plan room service (cProject) is included only with Associate Membership dues. Membership and commitments to pay dues continue until the chapter is notified in writing of cancellation, therefore, I, on behalf of the company, certify the statements are correct and true and agree, if approved, will follow the Constitution and By-Laws of the West Texas Chapter AGC (Association) and AGC of America as long as I (we) continue as a member.Select Membership Type: Associates - Subcontractor ($1760.00 Annually)Associates - Supplier ($1,760.00 Annually)Professional Services - Architects and Engineers ($600.00 Annually)Professional Services - Accountants, Bankers, and Financial Professionals ($600.00 Annually)Professional Services - Bonding Agents and Insurance Agents ($600.00 Annually)Professional Services - Others ($600.00 Annually)Name:Title: Date: After you press the SUBMIT button, the form may take several seconds to upload. Please do not leave the page until you have received the "Thank You For Submitting Your Application" message. PreviousSubmit
