To receive a certificate of participation, please complete the entire form. If you have any questions, please contact Nazia Shah at nazia.shah@agc.org or (703) 837-5409.

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* 1. Company Information

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* 2. Which AGC chapter(s) do you belong to?

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* 3. Contact Information (person completing form)

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* 4. How many years have you participated in Construction Safety Week?

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* 5. When and where (city, state) did your event take place? You can input multiple dates and locations.

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* 6. Explain the details of your event below, including the topic/focus of the event. If you had different events at different locations, list the location and then describe the event. 

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* 7. How many of your employees participated in construction safety week, across your company and jobsites?

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* 8. Information for certificate

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* 9. Do you have photos form your event that you would be willing to share with us?

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* 10. Is there any additional information you would like to provide?

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