Application for Membership Dues and Fees Builder & Associate Dues - $460 per year Affiliate Dues - $100 per year (Must be an employee of a Builder or Associate Member and be authorized to join as an Affiliate.) Application Fee - $25 one-time fee "*" indicates required fields Section IName* First Last Email* Date MM slash DD slash YYYY Company*TitlePrincipal(s)Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office PhoneCell*FaxWebsiteBrief description of business (keywords for directory search)Builders Mutual Insurance Participant?* Yes No Section IIMembership Type* Builder Associate Affiliate Someone engaged in the building business with a current North Carolina General Contractors License.Anyone that engages in business that is relevant to the building industry.Must be an employee of a Builder or Associate Member and be authorized to join as an Affiliate. Product Name Price: Name of Qualified LicenseeProduct Name Price: Type of businessProduct Name Price: Member AffiliationSection IIIType of Business(Corporation, Sole Proprietor, etc.)Number of EmployeesSection IVReferences (other HBA of Craven & Pamlico Counties members)ReferencesPlease list references here.Section VConsent Statement I AgreeI agree to abide by the constitution and by-laws of the National Association of Home Builders, the North Carolina Home Builders Association and the Home Builders Association of Craven & Pamlico Counties.Credit CardCard Details Cardholder Name Questions regarding membership or this form may be directed the Home Builders Association of Craven & Pamlico Counties at 252-636-3707 or info@newbernbuilders.comApplication Fee Price: Credit card processing fee Price: $0.00 Total
