Application for Company Membership

Application for Company Membership
Please submit complete Company Membership Application with at least one (1) CxA Application to be considered for approval.
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone Number*
Fax
Date of Incorporation*
MM slash DD slash YYYY
Website Address*
Number of Employees*
Primary Contact*

(must be an applying/current CxA)
Primary Contact Email Address*
Enter Email Confirm Email
Parent Company*
Company Subsidiary(ies)*

(if applicable)
1. Please list the full scope of services provided by the company:*
2. Please describe all configurations under which your firm delivers commissioning (Cx) services:*
If approved for ACG membership, our company agrees:*
- 1. To provide professional, independent commissioning services on behalf of the owner.
- 2. To uphold professional and ethical standards of conduct.
- 3. To keep at least one (1) ACG Certified Commissioning Authority (CxA) employed at all times in order to maintain membership. (Should the only CxA leave, the company would have a 3-month grace period to have a new CxA certified.)
- 4. To abide by the ACG Bylaws and Policies and Procedures.
- 5. That our membership will only remain valid while our membership dues status remains current. Dues are currently $2,000 per year, and include discounted certification fees, and one CxEnergy registration.
Application Submitted by (print name)*
Title*
Signature*
Date*
MM slash DD slash YYYY

74001

Membership & Certification