Join Now

Name:_____________________________________________

Address:____________________________________________

City, State, Zip:_______________________________________

Telephone Number:____________________________________

E-mail:_______________________________________________

Real Estate License No.__________________________________

Social Security No. _________________________________

Business Cards:  Yes _____       No _____  [$70.00 Charge]  Business Cards are optional.

Membership Fee - $99.00 per year – Please send check

Please complete the above form and mail along with your check to:

          BDR Referral Group

          P O Box 491638

          Leesburg, FL 34749

BDR Referral Group
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