Become a Member

It is easy to join CCS. Just follow the steps in the form below.

Company Information
Company Name*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Is this also your mailing address
- Yes
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Primary Contact Information
Primary Contact Name*
First Last
Title*
Email*
Phone*
Safety Director Contact Information
Safety Director Name (If different from Primary Contact above)
First Last
Title
Email
Phone
Toolbox Talk Application
With your membership you receive one free user to the Safety Meeting App (toolbox talks). Who would you like to be your user?
Name
First Last
Email
Phone
Company CEO Information
CEO Name
First Last
Title
Email
Phone
Account Billing Information
Billing Contact Name
First Last
If no billing contact is entered we will reach out to the Primary Contact regarding billing.
Billing Contact Title
Billing Contact Email
Membership Type*
Amount Due
$0.00
Would you like to pay by check or credit card?*
- Check
- Credit Card
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please make your check payable to Coalition for Construction Safety, Inc. and mail to:

Coalition for Construction Safety, Inc.
6510 Telecom Dr., Suite 200
Indianapolis, IN 46278

Once we receive your payment, we will send you a welcome packet in the mail with information about all the benefits that come with membership including participation in the CCS Certification Program.
Number of Hard Hat Stickers you would like for your employees?