WCR - Kansas City Mo Northland Chapter
Affiliate Membership Application

 

 

First Name:

  

Last Name:

  

Business Name:

  

Business Address:

  

City:

State:

Zip

Business Phone:

Fax:

    

Email:

  

Website address:

  

Local Chapter:

  
     

Additional Name for Corporate membership

  

Additional Name for Corporate membership

  

Additional Name for Corporate membership

  

 

    

Referrals for new membership

  

Is there a committee you would enjoy helping with?

  
   
Individual dues = $50     Corporate dues (4 individuals) = $170

 

Print this form and mail a check for your fees.
Send a copy of the completed form and a check to:
Courtney Peters
RE/MAX of Kansas City/Platte Woods
Office: 816-777-5415
cpeters@kcnet.com