Member Application - Umpqua Valley HBA

As a member of Umpqua Valley Home Builders Association (UVHBA), there are many benefits! You can participate UVHBA signature events, complimentary education classes, discounted lead-based paint classes, networking options, discounts on fuel, phones, insurance and workers compensation, as well as multiple sponsorship opportunities offered throughout the year.

Please complete the following form to apply for membership.

Business Information
Company Name*
Phone*
Website
Email*
Business Description (200 char max):*
Directory Category:*
Business Keywords (enter a space between word):*
Comments/Questions
Contractor License:
How would you like UVHBA to benefit you?
How did you find out about UVHBA?
Full-time Employees
Part-time Employees
Physical Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Same as physical address

Street Address Address Line 2 City State ZIP Code
Social Networking
Please enter the URL for each social network you have an account for and would like to share with others.
Facebook
Twitter
Other
Primary Contact Information
Name*
First Last
Title*
Phone*
Cell Phone
Fax
Email*
Contact Preference:
- Email
- Phone
Address*
Same as physical address

Street Address Address Line 2 City State ZIP Code
Billing Contact Information
Name*
First Last
Title*
Phone*
Cell Phone
Fax
Email*
Contact Preference
- Email
- Phone
Address*
Same as physical address

Street Address Address Line 2 City State ZIP Code
Membership Dues $446 per year
Payment Option:
- Bill me
- I will bring in a check

Business Information

Social Networking

Primary Contact Information

Billing Contact Information

Membership Dues $446 per year