APPLICATION FOR AFFILIATE MEMBERSHIP

in the Greater Alexandria Area Association of Realtorsâ , Inc.

I hereby apply for affiliate membership in the above Board/Assn., enclosed is my check in the amount of (circle current quarter)

Oct.-Dec. 2011 / $240.00 Jan.-Mar. 2011 / $211.75

Apr.-Jun. 2011 / $183.00  Jul.-Sept. 2011 / $154.00

I hereby submit the following information for your consideration.

Name ______________________________________________________

Company Name ______________________________________________

Type of business or Profession __________________________________

Office Address _______________________________________________

City/State/Zip ________________________________________________

Area Code/Phone # _________________ Fax # ___________________

E-mail Address _______________________________________________

Does your office comply with zoning requirements for it location? __ Yes __ No

Residence Address ______________________________________________________

City/State/Zip __________________________________________________________

Home Phone # __________________________________________________________

Are you a member of any other Board/Assn. of REALTORSâ ? ___Yes __ No

If yes, name of Board _____________________________________________

Are you a member of any other trade association? ___Yes ___No

If yes, name of such association _______________________________________

Are you willing to serve on a committee? ___Yes ___No

Would you be interested I speaking at a general membership meeting on a topic related to your business? ___Yes ___No

What service can the Bard/Assn. provide for You? ______________________________________________________________________

　

　

_________________________________________________ _______________

Applicant’s Signature Date