Florida CCIM Chapter 2021 Membership Application

Florida CCIM 2021 Membership Application

To apply for membership, please complete all of the fields below:
Name *

First Name Last Name
Company Name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Are you interested in joining the FLCCIM YPN (Young Professionals Network, typically for ages 40 and under)? *

Yes No
E-mail *
Work Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
Alternate Number

Area Code Phone Number
Website
District *
All membership dues are non-refundable
2021 FLCCIM Membership Types:
- Standard Membership for NEW MEMBERS (non-students): $200 $100 (valid until 12/31/2021)
- Standard Membership renewal for EXISTING MEMBERS (non-students): $200 (valid until 12/31/2021)
- Student Membership (for active students currently attending a University AND taking classes for a real estate-related degree): $25 (valid until 12/31/2021)
PLEASE NOTE: Enrolling in CCIM classes does not qualify you as a "student" for the Student Membership rate.

Membership Type: *

2021 Membership (NEW members/Non-student) $ 100.00

2021 Membership Renewal (Existing members) $ 200.00

2021 Membership (Active Students Only) $ 25.00

If you're a student, what College/University are you currently attending?
Additionally, what real estate-related course(s) are you enrolled in?
Signature *
Signature Date *

Month Day Year
NOTE: Membership in a local CCIM Chapter does not in any way provide any additional rights or opportunities to use the CCIM logo, trademark, or benefits.
Should be Empty:

Florida CCIM 2021 Membership Application