Greater Baltimore Chapter

LOCAL AFFILIATE APPLICATION

$90.00 annually

 Note: All local memberships are solely individual memberships.

 Name: __________________________________________________________

 Company Name: __________________________________________________

 Company Address: ________________________________________________

 City/ State/Zip: ___________________________________________________

 Phone Number: _______________________  Fax: _______________________

 Mobile # ______________________Voice Mail # _______________________

 Residence Address: ________________________________________________

 City/State/Zip: ____________________________________________________

 Phone: _____________________  Home fax: ___________________________

 Please send mail to my   __ home    __ business ___

 Email Address: ___________________________________________________

                    Please make checks payable to WCR Baltimore
                          C/o Helen Hartman
                           VP – Membership, WCR Baltimore
                                    Long and Foster Real Estate, Inc.
                                    321 Main Street
                                   Reisterstown , MD  21136            

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