Membership Application Form
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701 East Court Avenue, Suite B
Phone: (515) 283-2424
Des Moines, Iowa 50309
Fax: (515) 244-6289
Membership Classification Applying For
Reason for joining AGC/I
Contractor
Visiting Contractor
(prime & sub)
Legislative Influence
Safety Services
Associate
Visiting Associate
(supplier/service provider)
Education/Training
Bid Information
Networking
Other?
G e n e r a l I n f o r m a t i o n
Company _______________________________________________________________________________________________________________
Mailing Address ___________________________________________ City _____________________________ State ___________ Zip __________
Street Address ____________________________________________ City _____________________________ State ___________ Zip __________
Billing Address____________________________________________ City _____________________________ State ___________ Zip __________
Phone __________________________________________________ Phone #2 ______________________________________________________
Fax ____________________________________________________ Toll Free _______________________________________________________
Website _________________________________________________ Date Established ________________________________________________
Has your firm ever been a member of the AGC of Iowa under its present name or any other name?
Yes
No
Is your firm a member of the AGC in another state?
Yes
No
If yes, which state is your home chapter? ______________________________
Contractor Only Questions: Is your firm:
Open Shop
Union
# of Employees ________ Annual Volume $ ______________________
Is your firm an Iowa DOT approved DBE?
Yes
B r a n c h O f f i c e s
(Please add additional offices on back)
Contact _________________________________ Title ____________________________ E-Mail Address _________________________________
Address __________________________________________________ City ____________________________ State ___________ Zip __________
Phone __________________________________ Fax _____________________________________ Toll Free ______________________________
P r i m a r y C o n t a c t
AGC uses this individual to communicate valuable information
Name __________________________________________ Title ____________________________ E-Mail ________________________________
M e m b e r s h i p D i r e c t o r y I n f o r m a t i o n
Describe the type of work or service you provide to the construction industry. (50 words or less please) ______________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Type of construction work that your firm is associated with (This will be your voting division. (Choose only one.):
PC Paving
AC Paving
Grading & Underground Utilities
Surfacing
Structures
Specialty
Associate
Company Officers Listed in Membership Directory (Please add additional names on back)
Name ___________________________________________ Title ____________________________ E-Mail ________________________________
Name ___________________________________________ Title ____________________________ E-Mail ________________________________
Name ___________________________________________ Title ____________________________ E-Mail ________________________________
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Parent category: Business