EmailMe Form - Application for Affiliate Membership

EmailMeForm

Membership Type and Experience *
Primary Affiliate Applicant (Check here if your Affiliate company is not established with Tri-County.)
Secondary Affiliate Applicant (Check here if you are joining under an existing Primary Affiliate member at the same office location.)
(NOTE: This section determines your membership fees as outlined on the payment page. Questions? Call 610-560-4800)
Full Name *
Nickname
Date of Birth *
MM / DD / YYYY
Cell Phone *
### - ### - ####
By providing their cell phone number, applicants for membership hereby acknowledge and consent to receive communications from the Association via the number provided on the application.
Email Address
(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.) *
Office Information
Please enter the COMPANY/OFFICE information in this section.
This information remains associated with the company record maintained by NAR and should reflect the COMPANY/OFFICE, not a specific employee.
Office Name (and branch location, if applicable) *
Office Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

PLEASE NOTE: The office address provided must be the registered business address associated with the office location where you work. If you operate as an LLC, work remotely, or work from a home office, please provide the corporate or registered business address associated with your company location.
Office Phone *
### - ### - ####
PLEASE NOTE: The office phone number must match the registered business phone number for the office location you are affiliated with. Personal phone numbers should only be used if they are the registered business number for your company or LLC.

We will list both your office and mobile phone numbers in our membership rosters.
General Company Email/Inbox *
Please enter the office/company general office email address if any, NOT YOUR EMAIL ADDRESS. This email remains associated with the company record maintained by NAR.
Company Web Site *
Company Logo *

Add File
Please give a brief description of your company. *
Member Information
Please enter YOUR information in this section.

This information remains associated with your contact record and should reflect your pertinent information, not the COMPANY/OFFICE.
Headshot *

Add File
Residence Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Preferred Mailing Address *
Office
Home
Please note: This address will appear on our membership roster and may be publicly displayed in Association publications for your company.
Preferred Phone *
Cell
Office
Please list any associations, professional organizations or governing bodies to which you belong. If none, please put N/A. *
Please select your area(s) of membership interest: *
Networking Events
Sponsorship/Speaking Time
Online Advertising
Electronic Key Service
IF you are an ATTORNEY, please provide your specialization:
Have you been referred to our organization by a current member of Tri-County Suburban REALTORS®? *
Yes
No
If yes, provide their name and company (only one can be listed)
If not through referral, how did you hear about our organization? *
Association Website
Association Event or Class
Social Media
Email Marketing
Professional Association (Chamber of Commerce, local business group)
Other
N/A, I was referred.
Select all that apply.
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.

By adding your mobile telephone number to your application with Tri-County Suburban REALTORS® you have provided consent to receive text messages to the provided phone number on a reoccurring basis. The text message may include but are not limited to notifications concerning your membership. Such text messages may be sent using an auto dialer by Tri-County Suburban REALTORS® or other texting on its behalf. Messages and data rates may apply. You, and not Tri-County Suburban REALTORS® or its service providers, are responsible for payment of such charges. You agree that Tri-County Suburban REALTORS® is not liable for delayed or undelivered text messages. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties. For help with text messages, email info@tcsr.realtor or call Tri-County Suburban REALTORS® at 610-560-4800. *

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 delivered to the association office. The application cannot be processed until received!)
Credit Card *

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
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 Marketing & Communications
Tri-County Suburban REALTORS®
1 Country View Road, Ste. 201
Malvern, PA 19355
Phone: 610-560-4800
Email: ldavis@tcsr.realtor
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Name
Date

Office Information

Member Information

Payment Information

Contact Information/Questions