Member Application v10-2024

Page 1 of 1     AGC Membership Application   Please complete all of the required questions. The Membership Committee will review your application and contact references before presenting your company to the Board of Directors for membership approval. After Board approval, you will be invoiced for annual membership dues. Dues must be paid within 14 days of invoice.   1. Organization Name* Enter the company name exactly as it should be displayed in the Member Directory.         2. Member Type* Select the Membership Type that best describes your business.   -- Please Select -- General Contractor Specialty Contractor Residential Builder Service Provider Support       3. Street Address - Physical Location* Enter the address for the business location.   Address Line 1   Address Line 2   City, State, Zip         4. Billing Address Enter the billing address if different from the physical address.   Address Line 1   Address Line 2   City, State, Zip         5. Online Member Directory Information* Enter information to be used for the Member Directory.   Website   Business Phone   Mobile Phone         6. Organization Primary Contact* Please enter the names and email address for the individual at your company who will be identified as the Primary Member. This name will be included in the Member Directory.       Name   Email Address   Phone/Mobile Number   Title Primary               7. Is your company applying for health insurance through KCIT?*   Yes No       8. Is your company applying for Workers Compensation insurance through Kentucky AGC/SIF? (Ky AGC Self-Insurers Fund)*   Yes   No       9. Have you ever been a member of an AGC chapter?*   Yes   No   If Yes, where?               10. Date Business Established*   mm/dd/yyyy       11. Additional Contacts (Optional) If you would like to add additional contacts for your company, please provide information below. Affiliates are company employees with access to your AGC member profile. Other contacts will be alerted related to AGC member activities and news. If no additional contacts are entered, the Primary will receive all communication from AGC.   Affiliate 1 (Name, email, phone)   Affiliate 2 (Name, email, phone)   Safety Contact (Name, email, phone)   Legislative Contact (Name, email, phone)   Education Contact (Name, email, phone)   Social Events Contact (Name, email, phone)         12. References* We will contact your references. Please provide 3 current AGC member references including company contact name and phone number. If you do not have references from current AGC members, please provide 3 company names/contacts from outside the AGC.       Company Name   Contact Name   Phone Reference 1       Reference 2       Reference 3             13. Social Media (Optional) The AGC uses social media platforms along with our newsletter to promote our member companies. Please let us know what social media platform you use and/or your handle.       Handle Facebook   Twitter   Instagram         14. Annual Dues Based on Volume of Work Completed in 2024 for General Contractor, Specialty Contractor, or Residential Builders. Service Providers pay flat fee of $850. Support members pay flat fee of $500.* Dues are based on volume of work completed the previous full year. If you are a Contractor or Builder, please select the amount of volume that is reflected in your financial statements for the year ended 2024. If you are a Service Provider or Support applicant, please select the applicable category.   $0 - $1,000,000 = Annual Dues $1,000   $1,000,001 - $2.5M = Annual Dues $2,000   $2,500,001 - $5M = Annual Dues $4,000   $5,000,001 - $10M = Annual Dues $6,000   $10,000,001 + = Annual Dues $8,000   Multi-hold company = Annual Dues $10,000   Service Provider Annual Dues = $850/yr   Support member Annual Dues = $500/yr       15. Owner or Primary Contact's Age Range Demographic information for the company primary.   < 30   30-40   41-50   51-60   61-70   71+       16. Owner or Primary Contact's Gender   Male   Female       17. Owner or Primary Contact's Ethnicity   White   Hispanic, Latino, or Spanish origin   Black or African American   Asian   Native American   Other, please specify               18. Business Certifications Is your business state certified in any of the following categories?   MBE   WBE   DBE       19. Directory Category* Select 1 to 5 categories for the AGC Online Member Directory. Category selections will assist directory users in finding and sorting members according to their specialties. You may choose more than 5 selections, but additional selections will cost $25/each during initial membership invoicing and during annual renewals. Select at least 1 response.   Select at least 1 response.   Communications   Concrete   Conveying Equipment   Earthwork   Electrical   Equipment   Existing Conditions   Exterior Improvements   Finishes   Fire Suppression   Furnishings   General Services - Commercial   General Services - Residential   Heating, Ventilation, and AC   Integrated Automation   Masonry   Mechanical   Metals   Openings   Other Sales & Services   Plumbing   Residential Builder   Special Construction   Specialties   Support   Thermal & Moisture Protection   Transportation   Utilities   Waterway & Marine Construction   Wood, Plastics, & Composites