SRRC Referred By:
Membership Application 2008 Official Use Only

Please check appropriate membership category:
Corporate Representative Service Representative
Service Company Type (select one):
Name:  Nickname:   Your Title:
Company Name:
Address:  City:  State:  Zip Code:
Telephone: - -  FAX:  E-mail:
What is your company's product/service?
Is your company a member of the employee relocation council? Yes  No
Are you new to the relocation industry? Yes No  If not, how long involved?
Do you hold any special designations?
CRP SCRP ABR CRB CRS GRI GMS Other
What are your job responsibilities?
Would you be interested in serving on any committees or in speaking? Yes No
Membership Dues - Deadline for renewing is February 15, 2008
  No Joining Amount
$75 per person for 1 year Service Membership (Max 4 per company) $
$50 for 1 year Primary Corporate Membership (1 per company) $
$20 per person for 1 year Associate Corp. Membership (unlimited) $
Make checks payable to Southeastern Regional Relocation Council (Tax ID # 59-3616323). Checks must accompany this form. Please Submit form and check to:
Southeastern Regional Relocation Council
8131 Vineland Avenue PMB 312
Orlando FL 32821
Membership Criteria (Completion is mandatory). Please click here to read membership criteria.
I, as supervisor of the applicant, hereby designate  to represent our company as a member of the Southeastern Regional Relocation Council. I understand that each service company have have a maximum of four paid members in SRRC. Each applicant must have a separate application.
Company Name:
Print Supervisor's Name:
Supervisor's Telephone: - -
Your Paypal Email Address (If paying with Paypal):

OR
Applicant keep one photocopy and submit original