MEMBERSHIP APPLICATION

Name:____________________________________________________________ E-Mail:__________________________________________________________ Cell:______________Home phone:_____________Date of Birth:________ Home address:____________________________________________________ City:______________________State:___________Zip Code:____________ Your Specialty:__________________________________________________

Business Information

Business Name:___________________________________________________ Business type:___________________________________________________ Business address:____________________________How long?___________ City:______________________State:___________Zip Code:____________ Phone:____________________Fax:________________Position:__________

Spouse Information if Joint Membership

Name:____________________________________________________________ E-Mail:__________________________________________________________ Cell:________________Home phone:_____________Date of Birth:______

Payment Information ($50 per person/$75 per couple - ask about corporate rates)

Cash:________Check #:________Charge Card:__M/C__Visa-(circle one)Charge Card #:___________________________________________________ Expiration Date:_______________________Billing ZIP:______________

Signatures

I agree to follow the Code of Ethics of the MO-KAN Real Estate Investor Network. Any violation could result in cancellation of my membership.

Signature:_________________________________Date:_________________

Spouse/Partner:____________________________Date:_________________

Make checks payable to:

MO-KAN REIN LLC. P.O. Box 1942 Independence, MO 64055

Print page, fill out and FAX to: 816-286-2800