Affiliate Member Application "*" indicates required fields You will be contacted by LBAR Staff for payment once your application is received and ready to be processed. APPLICATION FOR AFFILIATE MEMBERSHIP Affiliate Members are individuals who represent a firm related to the real estate profession such as title insurance companies, lending institutions, attorneys, builders, home inspectors, appraisers, and companies that provide other home services. I hereby apply for Affiliate Membership in the Loveland-Berthoud Association of REALTORS. This will be returned to me in the event of non-acceptance of the application by the Board of Directors. I understand that if approved for Affiliate membership, the amount enclosed will be the total amount of dues required for membership from the date of this application to the end of the current fiscal year. (LBAR’s fiscal year runs from October 1 through September 30). I further acknowledge that this membership does not permit me to use the term “REALTOR®” and I am not entitled to vote on any REALTOR® matters. I hereby grant LBAR my express written consent to contact me at their discretion by U.S. mail, fax, telephone, or e-mail. I understand that by providing my street address, e-mail address, telephone number(s), and fax number(s), I consent to receive communications sent from LBAR via regular U.S. mail, e-mail, telephone, or facsimile at those numbers/locations. AFFILIATE MEMBERSHIP POLICY REGARDING MEMBERSHIP CHANGES Affiliate Membership in the Loveland-Berthoud Association of REALTORS® is only accepted on an individual basis. It the responsibility of the person on this application form to notify LBAR of any changes to your membership information such as, name, email, office, phone, etc. within 30 days.Applicant's Signature* Date* MM slash DD slash YYYY Name* First Last Nickname Title* Company Name* Company Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Phone*Cell Phone*Email* Would you like to have your email address published on the LBAR website?* Yes No Website Address* Mailing Address* Same as Company Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a Licensed Mortgage Broker?* Yes No License Number* If you are exempt, please state reason:Do you hold an active Colorado Real Estate license?* Yes No Do you want to be included on our Email YPN List?* Yes No What type of business are you in?*Please check maximum of 3. Accounting Advertising Appraisal Banking / Financial Builder Computers Decorating Services Gifts Home Inspection Home Warranty Insurance Internet Services Home Services Mortgage Lender Publications Remodeling Rentals Telephones / Cell Phones Title Company Other If other, please specify:* CommentsThis field is for validation purposes and should be left unchanged. Δ