South Central Board of Realtors
P.O. Box 2252, Brenham, TX 77834
979-836-2011
Affiliate Membership Application
When you have completed this application, please return it by email or mail.
Please circle which membership you are applying for:
Affiliate Public Service Honorary Student
Name of Firm: ______________________________________________________
Type of Business: ____________________________________________________
Contact Person: _____________________________________________________
Mailing Address: ____________________________________________________
__________________________________ Phone #: ________________________
Email Address: _____________________________________________________
Are you a member of an Institute, Society, or Council Affiliate with the National Association of Realtors: ________________
If yes, please indicate the name of the affiliate: ____________________________
Are you an affiliate with another board of realtors? __________________
If yes, what board are you a member with: ________________________________
What professional designations, if any, do you hold? ________________________
__________________________________________________________________
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, if granted.
Signature: _____________________________________ Date: _______________