Affiliate application - St. Charles County Association of REALTORS®

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AFFILIATE APPLICATION

Affiliate or Affiliate Associate Application for Membership

To: The St. Charles County Association of REALTORS®

On behalf of
I/we hereby apply for: company, organization or individual Membership

Affiliate/Affiliate Associate membership in the St. Charles County Association of REALTORS® (hereafter the "Association"). I/we hereby apply for membership in the Association and agree to abide by its Bylaws, Policy Manual, and the REALTOR® Code of Ethics. I consent that the Association may invite and receive information and comment about me or the company I represent from any member or other person, and I further represent and agree that any information and comment furnished to the Association as a result of this inquiry may be used to make a determination regarding this membership application and will be regarded as both privileged and confidential. I further irrevocably waive all claims against the Association particularly regarding acts in electing or failure to elect, advancing, suspending, expelling or otherwise disciplining me or the company I represent as an applicant, or as a member. I agree to allow the Association to furnish member contact information to both members and non members. In addition, I specifically authorize the Association, the Missouri Association of REALTORS® and NAR to communicate with me at the addresses given or future addresses used in the course of business via U.S. Mail, email, telephone and facsimile. I understand that money owed to the Association by me or the company I represent that is not paid within 30 days of the due date is subject to 1.5% per month service charge and a $15.00 per statement charge.

Company Name:	Phone:	Fax:
Contact Name:	Address:	City, State, Zip+4:
Contact Position: Independent Contractor \| Employee \| Other		Voice Mail / Pager:
If Other:		Cell Phone:
	Email:	Contact's Birth Date:

Yes No	Does the Contact hold a Real Estate License?
Yes No	Does Contact hold an Appraiser's Certificate?
Yes No	Prior to this application, have you or the company you represent ever been a REALTOR® association member?
	If yes, association name: / Membership date:
Yes No	Have you or the company you represent ever been disciplined by the Missouri Real Estate Commission or any REALTOR® association?
	If yes, please explain:
Yes No	Have you ever been expelled or denied membership in a real estate association?
	If yes, please explain:

Membership Type:

Enclosed is $ Application Processing Fee (non-refundable) and $ Dues for the calendar year that ends December 31, that is returned in the event of non-election. TOTAL $
Applicant's Name:	Date:


Affiliate Member	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
Local Association	175.00	160.00	146.00	131.00	117.00	102.00	88.00	73.00	58.00	44.00	29.00	15.00
Application Fee	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00
Total	275.00	260.00	246.00	231.00	217.00	202.00	188.00	173.00	158.00	144.00	129.00	115.00

Affiliate-Associate Member	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
Local Association	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00
Total	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00	50.00
NOTES: 1. Applies to second and subsequent members from the same office. 2. No application fee charged.
Affiliate Membership at State Association	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
State Association	150.00	138.00	125.00	113.00	100.00	88.00	75.00	63.00	50.00	38.00	25.00	13.00
Application Fee	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00
Total	250.00	238.00	225.00	213.00	200.00	188.00	175.00	163.00	150.00	138.00	125.00	113.00
NOTES: 1. State Association (MAR) membership is optional for Affiliates.