Couincil of Industries West Contra Costa County
Council of Industries
   
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COI Application for Membership

COUNCIL OF INDUSTRIES
APPLICATION FOR MEMBERSHIP

Please fill out the following information and press the SUBMIT button. You will receive an e-mail confirmation when the completed form has been received at the COI office. Your application will be presented for review by our Board members at their next meeting. Should you wish to have a paper form mailed and/or faxed to you, please e-mail your request to: kpruk@sbcglobal.net. If you have any questions, please give us a call at the COI offices: (510) 215-9325.

Name of Firm
*
Physical Address
*
Physical Address
Mailing Address
*
Mailing Address
City
*
State
*
Zip
*
Telephone
*
Fax
*
Description of Firm's Business
*
Web Site
Number of Employees in West Contra Costa County
*
Assessed Valuation for Most Recent Tax Year
*
Name
*
Title
*
E-mail Address
Desired Membership Status* Regular Member
Associate Member
Comments

* Required Field

 
Council of Industries   •   1306 Canal Blvd., Richmond, CA 94804   •   Phone: (510) 215-9325   •   FAX: (510) 215-9029   •   Email: coiwccc@sbcglobal.net
 
 
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