HMSDC Corporate Member Application

Corporate America’s Leading Connector to Minority Business Growth
Houston Minority Supplier Development Council Corporate Membership Application

Three Riverway, Suite 555, Houston, Texas 77056
APPLICANT INFORMATION
Date*

MonthDayYear
Date
Company Name*
What is your primary industry?*
Annual Revenue from Previous Year*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Brief description of company products/services
Principal Contact Name*
Principal Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Principal Contact Title*
Principal Contact Email*
example@example.com
If you were referred to the HMSDC, please list the referring company's name:
Membership Dues Guidelines
Your membership contribution avails you of full membership privileges in the Houston Minority Supplier Development Council (HMSDC).

Membership Benefits:

1. Supplier Diversity Program Sharing & Best Practices

2. Supplier Sourcing

3. Advertising in HMSDC communications (Weekly Alert, Website, Social Media)

4. Attend and Host Marketplace events (How to Do Business, Industry Forums)

5. Engagement Sponsorship Opportunities

6. Discount Signature event registration and sponsorships

All contributions to HMSDC are tax-deductible as charitable/educational donations under Section 501(C)3 of the Internal Revenue Service Code.

HMSDC TAX ID# 76-045-8224.

Dues Structure

Businesses frequently ask what should be their appropriate level of membership. The guidelines offered below were developed by corporate members of HMSDC to assist in that determination. Membership dues are based on the total number of employees of the business entity and its subsidiaries, not the number of employees in the HMSDC service territory.

Corporate Dues Guide

Rows	Corporate Dues Amount
Non Profit & Government $2,000
1-499 Employees $3,000
500-999 Employees $4,000
1,000-4,999 Employees $5,000
5,000-9,999 Employees $6,000
10,000+ Employees $7,000

Commitment
YES, we are committed to minority business development and wish to become a member of the Houston Minority Supplier Development Council. Please send membership materials to the person listed above.
YesNo
Charge my credit card for the dues amount indicated aboveInvoice me for the dues amount indicated abovePay via ACH - *use code "ACH" at check out
Support Services
We request Identification of Minority Business Enterprises (MBEs) specializing in the following areas:*
Personal review and guidance with developing our minority business development programBuyer/Advocate training in minority business developmentNetworking with MBEs and other corporationsOther
Please list the current point of contact for the following:

This information is for internal use only to ensure the appropriate contact receives targeted key meeting invites for HMSDC Signature Events
YES
Events

Please enter the name of the person that should receive invitations to general meetings and events
Contact Name*

First NameLast Name
Contact Title*
Contact Email*
example@example.com
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
YESNO
Communications

This information will appear in our internal corporate member contact directory. These contacts will receive regular communications from HMSDC including our weekly newsletter.
Primary Contact*

First NameLast Name
Primary Contact Title*
Primary Contact Email*
example@example.com
Secondary Contact Name

First NameLast Name
Secondary Contact Title
Secondary Contact Email
example@example.com
Tertiary Contact Name

First NameLast Name
Tertiary Contact Title
Tertiary Contact Email
example@example.com
Procurement Opportunities

This person should be the primary liaison to set up introductory meetings with MBE Suppliers and to discuss procurement opportunities within your company.
Procurement Contact Name*
Procurement Contact Title*
Procurement Contact Email*
example@example.com
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supplier Diversity Lead
SD Contact Name*
SD Contact Title*
SD Contact Email*
example@example.com
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SD Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplier Diversity Advisory Committee (SDAC) Participant
Contact Name*
Email*
example@example.com
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Yes, I agree to allow HMSDC to send PUSH Notifications to the mobile number listed above.No, I do not want to have event and important industry notifications sent to my mobile phone.
Employee Volunteer Organizations/Affinity Groups

This person will be contacted when we have a need for volunteers for our Signatures events.
Contact Name
Email
example@example.com
Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Chief Procurement Officer (CPO) Contact Information

This contact information will be used to invite the CPO to our Annual CPO Summit and other Executive Forums. At that event, a published contact list is provided only to attendees.
Chief Procurement Officer Name*

First NameLast Name
CPO Email*
example@example.com
CPO Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
CPO Administrative Assistant Name

First NameLast Name
Administrative Assistant Email
example@example.com
Administrative Assistant Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Corporate Referral
YESNO
Referred Company Name
Primary Contact Name
Primary Contact Title
Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
The undersigned hereby certifies that he or she is duly authorized to enter into this agreement, agrees to the pricing, payment terms, rules and regulations, and all other terms and conditions set for by The Houston Minority Supplier Development Council.
Printed Name*
Signature

Clear
Date*

MonthDayYear
Date

Corporate Dues*

USDEnter amount based on dues structure above.

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Corporate America’s Leading Connector to Minority Business Growth

APPLICANT INFORMATION

Membership Dues Guidelines

Commitment

Support Services

Please list the current point of contact for the following:

Events

Communications

Procurement Opportunities

Supplier Diversity Lead

Supplier Diversity Advisory Committee (SDAC) Participant

Employee Volunteer Organizations/Affinity Groups

Chief Procurement Officer (CPO) Contact Information

Corporate Referral