Membership Application

Membership Application
Membership Type

BuilderAssociate
Company Name
Owner/Applicant Name

First NameLast Name
Phone Number

Area CodePhone Number
Fax

Area CodePhone Number
Cell

Area CodePhone Number
Email
example@example.com
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This address is a residence (if this address is your home, we will NOT publish it without permission)

YesNo
Mailing Address (leave blank if same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this business have a previous name? (if no, leave blank)

Affiliate Contact

One Affiliate is included with your membership
Affiliate Contact Name (1affiliate is included with your membership)

First NameLast Name
Affiliate Email
example@example.com
Affiliate Work Phone Number

Area CodePhone Number
Affiliate Cell Phone Number

Area CodePhone Number

Builder Applicant Information

Associates skip this page by clicking next
State Builders License No.
If available, upload a copy of your builders license here

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Agreement
In making this application, I agree to abide by the constitution, bylaws, and code of ethics of the Home Builders Association of Great Lakes Bay Region. In event of termination of my membership of this association, I agree to immediately discontinue use of its logo in any form.

I give the HBA of Great Lakes Bay Region permission to send faxes, emails and letters to the addresses above.

By signing this form electronically, I assure that the given information is true and correct to my best knowledge. I agree to follow the above conditions and any payment plans I have chosen.
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Affiliate Contact