Concrete Masonry Checkoff Board Member Application Form

Concrete Masonry Checkoff Board

Member Application Form

Concrete Masonry Product Manufacturers requesting consideration to be appointed a Concrete Masonry Products Board (CMPB) member or alternate Board member must complete this digital form.

Provide all background information about the nominee, whether yourself or another being nominated, particularly information which is relevant to evaluating the qualification of the nominee.

Relevant information should include not only industry experience but also other information such as industry association leadership, experience with economic/business development organizations, Chambers of Commerce, certifications etc. Supporting documents can also accompany the application form.

MORE INFORMATION FROM THE DEPARTMENT OF COMMERCE CAN BE FOUND HERE.

Applicant Name*

Company Name*

Statement of Parent or Subsidiary Company*

If you applied with your parent company, please just state that it is the parent. If you applied as a subsidiary, we need a statement as to who the parent company is.

Applicant Bio*

Statement of Interest in the Board Position*

Date Submitted*

Manufacturing Plant Information

Street*

City*

State*

Zip Code*

Phone*

Phone

Email*

Number of Plants*

Number of Block-producing Machines*

Number of Block-producing Cavities*

Number of Employees*

Check all the types of concrete masonry products that apply:

Select all that apply

Select

Select all that apply

Select or enter value

Select all that apply

Select or enter value

Select all that apply

Select or enter value

Check all that apply:

Manufacturer of Concrete Masonry Products

I am a Manufacturer of Concrete Masonry Products and have manufactured CMP within the last 180 days.

USDOC may request documentation to verify your eligibility.

Consideration to be appointed

I request consideration to be appointed a Concrete Masonry Products Board member or alternate member.

Trade organization

I am not an employee of an industry trade organization exempt from tax under Section 501(c)(3) or 501(c)(6) of

Title 26, U.S. Code representing the concrete masonry industry or related industries.

Employee of an industry trade organization

I do not concurrently serve as a board of directors officer of a national concrete masonry products industry

trade association.

Additional Information

Use this link to upload any additional documentation or a written statement for consideration.

Drag and drop files here or

Send me a copy of my responses

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