Membership Application

APPLICATION FOR MEMBERSHIP

Payment Schedule

Membership Year: June 1 — May 31
RELA Dues: $325

NOTE: Membership in RELA is open to LENDERS and EQUITY PROVIDERS only. Submission of this Application for Membership shall be construed as the individual's attestation to eligibility for membership.

This dues payment is not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense to the extent permitted under IRS Code.

Please submit completed application and payment to:

Real Estate Lenders Association, Inc.
551 Fifth Avenue, Suite 3010
New York, NY 10176
Ph. 212-692-9379 • Fax 212-687-4016

CONTACT INFORMATION

Last Name

First Name

Nickname for Name Badge

Middle Name/Initial

Title

Company

Address (Line 1)

Address (Line 2)

City

State

ZIP Code

Business Phone

Extension

Business Fax

Cellular

Home Phone (for office use only)

Email

Payment Form

[ ] Check payable to RELA

[ ] Visa

[ ] MasterCard

[ ] Amex

Card Number

Expiration Date

Card Security Code

Cardholder's Name