Membership Application

ANY Minority Business Enterprises (MBE only)

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* MBE Ownership

African American

Asian American

Hispanic American

Native American

Women Owned

Veteran Owned

Disabled

* Business Start Date

* Area(s) of Operation

Twin Cities

Greater Mn

North Dakota

South Dakota

Iowa

National

* Union Affiliation

Union

Non-union

* Membership Type

$250,000 and below gross revenue annual membership is $200.00

$250,001-$1,000,000 gross revenue annual membership is $500.00

$1,000,001-$5,000,000 gross revenue annual membership is $1000.00

$5,000,001 and above gross revenue annual membership is $2000.00

* Self Performance

Yes

Self Performance Area(s)

Work Classification (check ALL that apply)

Residential

Commercial

Highway Heavy

Supplier

Professional Services

Other

Other Work Classification

NAICS Code(s)

* Certifications you currenty have

CERT

DBE

TGB

SBA 8(a)

MMSDC

SECT 3

None

What is your companies average job size?

Percentage of Public Contracts

* Do you currently have bonding capabilities?

Yes

What is your maximum bonding limit?

What is your single project bonding limit?

What is the largest bond you have received?

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

Certification Assistance

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date

Affiliates (non-MBE Contractor, not supplier or professional services)

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* Business Start Date

* Area(s) of Operation

Twin Cities

Greater Mn

North Dakota

South Dakota

Iowa

National

* Union Affiliation

Union

Non-union

* Membership Type

$250,000 and below gross revenue annual membership is $200.00

$250,001-$1,000,000 gross revenue annual membership is $500.00

$1,000,001-$5,000,000 gross revenue annual membership is $1000.00

$5,000,001 and above gross revenue annual membership is $2000.00

* Self Performance

Yes

Self Performance Area(s)

Work Classification (check ALL that apply)

Residential

Commercial

Highway Heavy

Supplier

Professional Services

Other

Other Work Classification

NAICS Code(s)

What is your companies average job size?

Percentage of Public Contracts

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date

Supplier (non-MBE Equipment & Materials Supplier)

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* Business Start Date

* Area(s) of Operation

Twin Cities

Greater Mn

North Dakota

South Dakota

Iowa

National

* Membership Type

Supplier (MBE discount offer) annual membership fee is $1000

Supplier (no MBE discount offer) annual membership fee is $2000

Work Classification (check ALL that apply)

Residential

Commercial

Highway Heavy

Supplier

Professional Services

Other

Other Work Classification

NAICS Code(s)

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date

Professional Services (non-MBE)

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* Business Start Date

* Area(s) of Operation

Twin Cities

Greater Mn

North Dakota

South Dakota

Iowa

National

* Membership Type

Professional Services (MBE discount offer) annual membership fee is $500

Professional Services (no MBE discount offer) annual membership fee is $1000

NAICS Code(s)

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date

Non-profit Organization (non-MBE)

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* Business Start Date

* Area(s) of Operation

Twin Cities

Greater Mn

North Dakota

South Dakota

Iowa

National

* Membership Type

Non-profit annual membership fee is $300

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date

Government Agencies

* Company name

* Contact Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Telephone

Fax number

* Email Address

Website Address

* Business Start Date

* Membership Type

Government Agencies annual membership fee is $500

* What services would you like to see from NAMC?

Current Issues

Advocacy/Legislative & Regulatory Support

Financial Support or Assistance

Training

Procurement Opportunities

Networking

How did you hear about NAMC?

Notes / Comments

ACCEPTANCE OF APPLICATION

If this application is accepted by the board of direction, By signing and dating below, The member company agrees to abide by the bylaws of the organization.

* Signature

* Date