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Firm Name:*

(As Listed with the Licensing Board

Contact Person:*

(/ UMCNC Representative)

Contact Email:*

Year Established

Mailing Address*

City

State

Zip Code

Phone*

Fax

Email*

Website

Type of Contractor License*

Limited
Unlimited
Intermediate

Primary NAICS Code

Head of Company

(if different that above)

Title

Email Address

Include name on web site Member Search and printed Membership Roster?*

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Type of General Contracting (Fill in Percentage)

Highway %

Building %

Utility %

General Contracting Experience Categories(Check all that apply)

Membership Levels

- One (1) Annual Membership - Monthly Meetings (no fee) - One (1) Member Vote

- One (1) Annual Membership - Monthly Meetings (no fee)

- Two (2) Annual Memberships - Monthly Meetings (no fee)

- Four (4) Annual Memberships - Monthly Meetings (no fee) - Four (4) Members Vote

- One (1) Annual Membership - Monthly Meetings (no fee)

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Membership Application

Type of General Contracting (Fill in Percentage)

General Contracting Experience Categories(Check all that apply)

Membership Levels

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