Company Name:

Street Address:

City: State: Zip: -

Contractors License#:

Description of Business:

Telephone#: Fax#:

Email Address:

Web Site:

Number of Company Employees:

Delegate to Association: Mr. Ms.

Delegate Home Address:

City: State: Zip: -

Telephone#:

Delegate's Voting Ward/Township:

Personal Information (i.e., spouse, children, awards, etc.):

Builder Member Associate Member:

Submitted for Membership By:

I hereby agree to abide by the Constitution and By-Laws of the National Association of Home Builders of the United States, the North Carolina Home Builders Association, and the Home Builders Association of Gaston County. In the event of termination of membership in this Association, I agree to immediately discontinue the use of any and all insignia in any form.

I hereby authorize the Home Builders Association of Gaston County to bill me in the amount of $400.00 to the above address. This will cover my first year of membership dues. I certify that I am authorized by my company to enter into this agreement.