Application for Membership Dues and Fees Builder & Associate Dues - $460 per year Affiliate Dues - $100 per year Application Fee - $25 one-time fee "*" indicates required fields Section IName* First Last Email* Date MM slash DD slash YYYY Company* Title Principal(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*FaxWebsite Brief 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.An additional person in an existing builder or associate members business that desires the benefits of Association membership. Product Name Price: Name of Qualified Licensee Product Name Price: Type of business Product Name Price: Member Affiliation Section 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
