MEMBERSHIP APPLICATION

APPLICANT FIRM: ______________________________________________________________________________________

MAILING ADDRESS: (Street, PO Box, RRD)-_________________________________________________________________

CITY: __________________________________ STATE: ______________________ ZIP + 4: _________________________

PHYSICAL ADDRESS: (Street, RRD) _______________________________________________________________________

CITY: __________________________________ STATE: _____ ZIP + 4: __________________________________________

TELEPHONE #: _________________________ FAX #: _______________________ WATS #: _________________________

E-MAIL ADDRESS: _________________________________ WEB SITE ADDRESS: _________________________________

FIRM PRINCIPAL: (Full Name): ____________________________________ TITLE: _________________________________

CONTACT PERSON/SALE REP: (Full Name): _____________________________ TITLE: _____________________________

PRIMARY CONSTRUCTION TRADE SPECIALTY: _____________________________________________________________

OTHER TRADE SPECIALTIES: ____________________________________________________________________________

DATE PRESENT BUSINESS STARTED: ______________________AVERAGE # OF EMPLOYEES: _____________________

FINANCIAL & TRADE REFERENCES: __________________________________________________

Annual and Other Type Billings Should Be Forwarded To: (Check One) ________Applicant Firm _________ Other (Below)

COMPANY NAME: ______________________________________________________________________________________

ADDRESS: (Street, PO Box, RRD) _________________________________________________________________________

CITY: _______________________________________ STATE: ________________ ZIP + 4: __________________________

Mail Member Copy of “The Builders Bulletin” To: (Check One) ______________ Applicant Firm ___________ Other (Below)

INDIVIDUAL’S ATTENTION: ______________________________________________________________________________

ADDRESS: (Street, PO Box, RRD) _________________________________________________________________________

• MEMBERSHIP FEE: (please check one)

• Level One: $465.00 Annual Membership, Paid In Advance _________

• Level One: $260.00 Six-Month Membership, Paid In Advance _________

• Level Two: $1065.00 Annual Membership, Paid In Advance _________

• Level Two: $585.00 Six-Month Membership, Paid In Advance _________

Annual membership dues of $465.00 include $100.00 for a 1-year subscription to the Builders Bulletin of Central
Pennsylvania. (Incrementally, semi-annual membership dues of $245.00 include $50.00 for a 6-month subscription).

Membership dues are all-inclusive, and subscriptions to the Builders Bulletin or dues designated for other services
cannot be paid for on a fee-for service basis. Members of the Altoona Builders Exchange become subscribers of
the Builders Bulletin upon payment of membership dues. Subscriptions are available only to members.