| Membership List | Become a Member | Code of Ethics |
| MEMBERSHIP APPLICATION | |||
| Include all information that applies to you and your business. | |||
| (Information is strictly confidential and will not be reused for any purpose except to contact you) | |||
| Date:_________________ | |||
| Company Name:____________________________________________ | Contact Name:___________________________ | ||
| Mailing Address:_____________________________________________________ | Phone #:______________ | ||
| City:______________________ | State:__________________________ | Zip:_______________________ | Fax #:________________ |
| Physical Address:______________________________________________________________________ | Cellular #:_____________ | ||
| City:______________________ | State:__________________________ | Zip:______________ | Nextel ID #:____________ |
| e-mail address:__________________________ | |||
| Number of Years in Business:_______________________ | Federal Employer ID #:_____________________________ | ||
| Prior employment if less than 3 years:_________________ | AL State Business License #:________________________ | ||
| ______________________________________________ | General Contractor State License #:___________________ | ||
| Liability Insurance? Yes No | Pesticide Applicator License #:_______________________ | ||
| Workers Compensation Insurance? Yes No | Growers Plant Certification #:________________________ | ||
| Plant Dealers License #:____________________________ | |||
| Annual Volume of Sales: | Type of Business: | AL Setting of Landscape Plants License #:______________ | |
| ___ $ 0-$50,000 | ___ Educator | AL Landscape Designer License #:___________________ | |
| ___ $50,000-$100,000 | ___ Irrigation Contractor | ||
| ___ $100,000-$250,000 | ___ Garden Center | ||
| ___ $250,000-$500,000 | ___ Grower | Current Member of: | |
| ___ $500,000-$1,000,000 | ___ Landscape Contractor | ___ American Landscape Contractors Association | |
| ___ $1,000,000+ | ___ Landscape Designer | ___ Alabama Nursery and Landscape Association | |
| ___ Landscape Maintenance | ___ Alabama Turfgrass Association | ||
| ___ Rewholesale | ___ American Society of Landscape Architects | ||
| ___ Vendor | ___ Irrigation Association of Alabama | ||
| Other____________________ | ___ Southern Nursery Association | ||
| References: | |||
| Trade Reference: | |||
| Name:_________________________________________ | Education Background: | ||
| Phone #:_______________ | Fax #:__________________ | Degree: | |
| Trade Reference: | ___ High School or GED | ___ Associate | |
| Name:_________________________________________ | ___ Two Year College | ___ Bachelors | |
| Phone #:_______________ | Fax #:__________________ | ___ Four Year College | ___ Masters |
| Customer Reference: | ___ PhD | ||
| Name:_________________________________________ | Graduate? Yes No | Area of Study?______________ | |
| Phone #:_______________ | Fax #:__________________ | School_________________________________________ | |
| GBALP Member Reference: | How did you hear about GBALP?_____________________ | ||
| Name:________________________________________ | _______________________________________________ | ||
| Phone #:______________________________________ | _______________________________________________ | ||
| Fax #:________________________________________ | _______________________________________________ | ||
| I hereby submit this application and $100 (annual dues)* for membership in the Greater Birmingham Association of | |||
| Landscape Professionals. All statements made in this application by me are true. | |||
| Signature:_______________________________________ | Date:______________________ | ||
| * $50 Associate or Student Dues | |||
| Mail to: | |||
| GBALP | |||
| PO Box 383293 | |||
| B'ham, Al 35238-3293 | |||
Copyright © 2004-2005