EmailMe Form - Application for Affiliate Membership

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Membership Type and Experience *
Primary Affiliate Applicant (check here if company and location are not yet established with Tri-County)
Secondary Affiliate Applicant (check here if an additional affiliate applicant from a company and location an active primary Affiliate member)
(NOTE: This section determines your membership fees as outlined on the payment page. Questions? Call 610-560-4800)
Name *
Office Name (and branch location, if applicable) *
Office Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Office Phone *
### - ### - ####
Residence Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Cell Phone *
### - ### - ####
Preferred Contact Email (This will be your official email address in our system and connected to all of your membership benefits. If your email address changes, please contact Tri-County to update your contact information.) *
Company Web Site *
Company Logo

Add File
Headshot

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Preferred Mailing Address *
Office
Home
Preferred Phone *
Cell
Office
Please give a brief description of your company. *
Please list any associations, professional organizations or governing bodies to which you belong:
Please select your area(s) of membership interest: *
Networking Events
Sponsorship/Speaking Time
Online Advertising
Electronic Key Service
Have you been referred to our organization by a current Primary Affiliate member of Tri-County Suburban REALTORS®?
Yes
No
If yes, provide their name and company (only one can be listed)
Conditions of Membership

Affiliate membership in Tri-County Suburban REALTORS® is a privilege provided to individuals who do not hold a real estate license at a real estate company but have a vested interest in the industry. Affiliate membership is individually based. Other individuals of the company are not extended membership benefits unless they too join the organization.

I agree that, if accepted for membership in Tri-County Suburban REALTORS®, I will abide by the organization’s bylaws, rules and regulations. I shall pay the established fees due and payable. I understand that all dues and fees paid to the Association are non-refundable. I certify that the foregoing information furnished by me is true and correct, and any misstatement of fact may be grounds for revocations of my membership if granted. I understand that membership in the Association does not represent an endorsement or recommendation of said applicant and I am not permitted to indicate that the Association endorses any product or service offered by the member or company unless otherwise contracted. *

Name

Date
Payment Information
Membership Dues Breakdown by Month (per submission date of application)
Total Charges Based on Month Joining (per chart above) $ *
Commercial Chapter Affiliate Membership Fee (OPTIONAL, provides access to additional benefits and services geared towards the commercial real estate practitioner)
$25
Total Amount to be Paid (Charges plus Commercial Chapter Fee, if chosen) $ *
Method of Payment:
Credit Card (VISA/MC/AMEX/DISC)
Check (NOTE: there is not a telecheck option, checks must be mailed or personally delivered to the association office. The application cannot be processed until received)
Credit Card

Card Number

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Name on Card
Cardholder Address Option
Same as Residence Address
Different Address (please complete next question)
Cardholder Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Contact Information/Questions
Lauren Davis - Director of Membership
Tri-County Suburban REALTORS®
1 Country View Road, Ste. 201
Malvern, PA 19355
Phone: 610-560-4800; FAX: 610-560-4801
Email: ldavis@tcsr.realtor
Web: tcsr.realtor
Image
File Upload

Name
Date

Payment Information

Contact Information/Questions