LCRA Affiliate Online Affiliate Registration

Lewis Center Reaty Association Affiliate membership and

check payment form - Membership Fees - $20 affiliate - Pay $2 per meeting in advance Full year - $80.

Name *

Business/Organization name *

Phone Number for association's published database *

Area Code Phone Number

E-mail address *

Business type - category Drop-Down *

Business Website

Business Street address

Business Phone number

City

State

Zip code

My Membership Pledge *

I agree to support this Association by my attendance and participation. I further agree to abide by the BY LAWS/Regulations (www.lewiscenterra.org - LCRA) set forth by the membership. I also understand that the lewis Center Realty Association is a non-profit organization originated to foster business relationships and make charitable contributions. My participation in sponsored events, including weekly home tours, is voluntary and I agree to hold the Lewis Center Realty Association harmless in the event of any accident or injury I sustain through my participation.

Authorization *

I have read and agree to the above terms.

Payment by Check!

Select Options Below *

LCRA Annual Affiliate Membership - $25.00 LCRA Pay $2 for each in-person meeting or $75 membership and meetings for the whole year - $75 LCRA Website Basic Website Sponsorship - $ 52.00 LCRA Website Premium Sponsorship Top Row - Confirm Availability Before Purchase With Assoc. Board - $ 78.00 LCRA Website Corporate Sponsor - If available - Confirm Availability Before Purchase With Assoc. Board $ 258.00 LCRA Phone Corporate Sponsorship Only - AD Between Phone Membership Database - Confirm Availability Before Purchase With Assoc. Board - $ 310.00

Check # *

Total $ Amount *

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