Name _______________________________________________________________________________
DOB ________________________________________________________________________________
Signature ____________________________________________________________________________
Address _____________________________________________________________________________
City/State/Zip ________________________________________________________________________
Phone# ______________________________________ Cell# __________________________________
email _______________________________________________________________________________
______________________________________________
______________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Total Fee: $______________________
Please Charge my ( )( )( )
or contact Board office at (845) 735-0075 for additional payment options
Account No. ___________________________________________Security Code__________________
Expiration Date _______________________________________________________________________
Signature ____________________________________________________________________________
Mail Registration to: RCBOR
300 North Middletown Road
Pearl River, NY 10965
Fax Registration to: (845) 735-0415
LOCATION SITES:
Rockland County Board of REALTORS
300 North Middletown Road
Pearl River, NY 10965 (845) 735-0075
Rockland Community
College
145 College Road Suffern, NY 10901
(845) 574-4730
Rockland Community College
185 N Main Street
Spring Valley, NY 10977
(845) 574-470
(845) 574-4496
Rockland Community
College
37 West Broad Street & Maple Avenue
Haverstraw, NY 10927
(845) 574-4000
Holiday Inn
Orangeburg
329 Route 303
Orangeburg, NY 10962
(845) 359-7000
Hilton Garden Inn
270 Route 59 West
Nanuet, NY 10954
(845) 623-0600
