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Affiliate Membership Application

First Name
Middle Initial
Last Name


Company Name
Company Address
Office Phone
Office Fax Number
Cell Phone
Preferred Email Address
Website Address
Position or Title in Business
Business Category- Please select only one. (To be used on our webiste)


Application Fee - $75 
2021 Membership Dues - $160

Dues are pro-rated on a quarterly basis
1st Quarter (Jan-Mar) $160
2nd Quarter (Apr-Jun) $120
3rd Quarter (Jul-Sep) $80
4th Quarter (Oct-Dec) $40


I hereby apply for Affiliate Membership in the Bucks County Association of REALTOR®, Inc. I agree to abide by its Constitution, Bylaws and Rules and Regulations.  I irrevocably waive all claims against the Association or any of its officers, directors or members, for any act in connection with the business of the Association, and particularly as to its or their acts in electing or failure to elect or accept, advancing, suspending, expelling, or otherwise disciplining me as an applicant, or as a member.  Upon the expiration of said membership for any cause, I will return to the Association all certificates, signs, plaques, seals or other indications of membership in the Association. 


Signature (Please enter your full name)
Date of Application


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