<p> MORTGAGE BANKERS ASSOCIATION OF THE GENESEE REGION ______</p><p>GENERAL MEMBERSHIP APPLICATION AND DIRECTORY LISTING</p><p>MORTGAGE BANKERS ASSOCIATION OF THE GENESEE REGION</p><p>FIRM NAME:______</p><p>MAILING ADDRESS:______(Street, City, State ______and Zip Code) </p><p>PRIMARY CONTACT: </p><p>/ ______Telephone Number Fax Number ______e-mail address</p><p>The membership fee is $275.00. As the primary contact for your organization, please return your annual membership fee and complete the attached form for our mailing list. The more people who know about our meetings, the better the attendance will be.</p><p>Please return this complete form along with your check payable to: Mortgage Bankers Association c/o Mary K. Dawson Underberg & Kessler LLP 300 Bausch & Lomb Place Rochester, New York 14604 Phone (585) 258-2847 Fax (585) 258-3203</p><p>Membership fees are due January 15, 2017.</p><p>Topics I would be most interested in for the meetings are: </p><p>□ I am interested in joining a committee; please contact me.</p><p>MBA Committees consist of : ●Education ●Membership ●Community Outreach ●Website/Social Media</p><p>Additional names and addresses of individuals wishing to be on our mailing list:</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: _____ e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p><p>NAME: NAME:______ADDRESS: ADDRESS:______Phone No.: ______e-mail: ______e- mail______</p>