CSMB - Membership Application

MEMBERSHIP APPLICATION
New/Renew CSMB

Personal Data (Please fill in as completely as possible)

Full name: Mr.__ Mrs.__ Ms.__
First: _____________Middle Initial:___ Last:_______________________ Suffix:_____
Certification (s): __________________Nickname/badge name:_________________
Job Title:_________________________Company:______________________________
Street Address:______________________________________Suite#:______________
City: ______________________ State :______ Zip Code:________ Home Zip+4**:_____
Phone:(____)____________Fax*:(_____)____________E-Mail*:___________________
***Web Page Address: ______________________________________________
* CSMB sends faxes during off-peak hours and regularly sends legislative updates via e-mail.
** CSMB requests your home "Zip+4" so we may note Congressional districts of members.

*** We will put a link on our web page with a reciprocal link on your web page.
TYPE of Member: Occupation: Member $

__ BROKER Will include everyone in Brokers office $250.00
(Broker will be the voting member)

__AFFILLIATE MEMBER Attorney, Appraiser, PMI, Credit Bureau $150.00
(Will include everyone in Affiliates Office)

__LENDER Includes all of the account representatives in $400.00
the State

NOTE: MEMBERSHIP requires that this application be accompanied by a copy of your current State License showing date acquired. CSMB estimates that 76% of your 2009 dues are not deductible. Please indicate your
CSMB sponsor: Sponsor: _______________________________ Phone:(_____)______________

Company:____________________________________

Membership dues are not refundable for ay reason once application is processed and membership is granted.

Check_____ or Cssh ___Please read application, determine membership classification, print, fill in form, add signature and forward with payment for the appropriate amount to :

Membership Policies:

If any of your contact information changes, please phone CSMB at 203-874-3090 or fax changes to CSMB at 203-783-4828. The association is an Individual Member Society; there are no corporate memberships. Regardless of your membership classification in a state association, your record is maintained on an individual basis by CSMB.

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