Minnesota PHCC Contractor May/June 2018

MEMBERSHIP APPLICATION
Join online at www.mnphcc.org or complete the application below!
Membership is at the company level and ALL employees receive the benefits! Complete details about the
benefits can be found on our website at www.mnphcc.org. Company membership runs for one calendar
year, from January 1 - December 31.
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18
1
MEMBER INFORMATION
Please provide your company information below as you would like it listed in the membership directory.
Company Name:________________________________________________________________________________________________
Primary Contact:________________________________________________________________________________________________
Address:______________________________________________________________________________________________________
City:______________________________________________________________________State:_______________Zip:_______________
Phone:__________________________________________________ Fax:__________________________________________________
Email: _________________________________________________Website: ________________________________________________
Is your company: o Union o Non-Union
(This information will not be published but is used for us to track our membership demographics)
Would you like your company information to be listed in the MN PHCC membership directory? o Yes o No
(Please note that your information will be listed if an option is not selected)
2
PRODUCTS /
SERVICES
Please select which products /services your
company provides:
Plumbing
o Contractor Installation/
Repair/Maintenance
o Parts/Tools Wholesaler
o Parts/Tools Manufacturer
HVAC
o Contractor Installation/
Repair/Maintenance
o Parts/Tools Wholesaler
o Parts/Tools Manufacturer
Mechanical
o Contractor Installation/
Repair/Maintenance
o Parts/Tools Wholesaler
o Parts/Tools Manufacturer
o Business Service Provider for Contractors,
i.e. utility, CPA services, etc.
o OTHER: Please list the specific service(s) you
offer:__________________________________
______________________________________
______________________________________
3
ADDITIONAL EMPLOYEES
Please provide employee information for those that you want to
receive PHCC communications regarding CE classes, events, lobbying
updates, association updates, industry information, etc. Attach
additional names if necessary.
Name:_______________________________________________________________
Phone: ______________________________________________________________
Email: _______________________________________________________________
Name:_______________________________________________________________
Phone: ______________________________________________________________
Email: _______________________________________________________________
4
MEMBERSHIP TYPE
Please select your membership type below.
o CONTRACTOR Company - $1,350
$1,095 … over a 20% discount for first-time members!
o ASSOCIATE Company - $500
5
PAYMENT INFORMATION
o Visa o MasterCard o AMEX o Check #____________ (payable to MN PHCC)
Card Number: __________________________________ Exp. Date: ___________
Name on Card: ______________________________________________________
Signature: __________________________________________________________
PLEASE SEND YOUR COMPLETED FORMS WITH FULL PAYMENT TO:
MN PHCC - 5353 Wayzata Blvd, Ste 350, Minneapolis MN 55416 Phone: (952) 564-3060 | Fax: (952) 252-8096 | info@mnphcc.org
Your MN PHCC membership will be conveniently renewed at the start of each calendar year using the credit card noted above. This will guarantee
uninterrupted access to benefits, services and subscriptions. An email will be sent to you in December of each year as a reminder and will include the upcoming
years’ membership fee. If you do not wish to proceed with automatic renewal for an upcoming membership year, you must opt out before the second week of
December by emailing info@mnphcc.org.
By providing your credit card number above, you authorize MN PHCC to annually renew your MN PHCC membership and charge the applicable membership fee.
Send in your completed application and full payment right away to begin receiving benefits!
PHCC membership dues are not deductible as a charitable contribution for U.S. Federal income tax purposes, but may be deductible as a business expense.
For 2018, PHCC estimates that 5% constitutes lobbying expense.