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