AFFILIATE MEMBERS DATA FORM
RUTLAND COUNTY BOARD OF  REALTORS®
and
VERMONT ASSOCIATION OF REALTORS®

Date:_______/______/_______ Board # 48 (State)/___________________Local

AFFILIATE MEMBER:

Firm:___________________________________________________________________

Main Branch Address:_______________________________________________________

________________________________________________________________________

Contact Person:__________________________________________________________
                          (Last Name),   (First Name)  (Initial)

Type of Firm;_______________________________Telephone( )_____________________________

State Dues(VAR): $_______________Number of individuals joining:______________

Local Board Dues(RCBR): ___$75.00___  X   _____ (#) of Affiliate members joining: $______________

Fiscal Year:  10/1/______ -9/30/______

Quarter Joined(circle one): 1st   2nd   3rd   4th

TOTAL AMOUNT DUE $______________________________

Make Checks payable to: Rutland County Board of REALTORS®

and USPS Mail to: Attn: Nora Moore, Association Executive, RCBR, P. O. Box 1008, Rutland, VT 05702-1008.

Or direct FAX Forms Only, to: 1- 802-747-3451 and Mail checks separately.

Name,  address,   phone number,  email of Individuals of Firm joining this Local Board;

_______________________________________________________________________

_______________________________________________________________________

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