Affiliate Application

* Business Name

* Business Street Address

* Business City

* Business State

* Business Zip Code

* Business Phone Number

* Business Email

Business Fax Number

Business Web Address

Alternate Mailing Address if different

Alternate City

Alternate State

Alternate Zip

* Contact Person

Contact’s Cell Phone Number

Contact’s Email

Franchise

Parent Company

Main Office

Business/Service Provided

* Have you ever been a member of another REALTOR® Association?

Yes
No

If yes, please provide the Association name, dates of membership and your NRDS number

Our clients entrust our REALTOR® members with their homes and personal possessions/information. We must do our best to ensure that our AFFILIATE members are held to the same standards as Washington State Real Estate Licensees. Please call the association office with questions.

* Have been convicted of a felony within the last three years?

Yes
No

I hereby apply for AFFILIATE membership in the Lower Columbia Association of REALTORS®. I agree to pay the Affiliate member dues and application fee as noted on the rate schedule. Affiliate members are invoiced for each new year of membership at the end of the previous
year.

I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information, as requested, or any misstatement of fact, may be grounds for revocation of my membership.

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