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Membership Application

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	First Name *
	Last Name *
	Address *
	City *
	State *
	Zip Code
	Home Phone *
	Home Fax
	Work Phone
	Work Fax
	Cell Phone
	Email *

	*Your Commitment*

	Time Donation * I will donate up to 100 hours of my time if called upon to do so over the next twelve months and each twelve months thereafter as long as I wish to remain as an Eagle.	Yes No

	Purchase Promise * I will purchase 100 copies of How To Be A Quick Turn Real Estate Millionaire at a bookstore within 30 days from today. I agree not to display the book in any electronic format anywhere online for sale.	Yes No

	Certification * By submitting this application, I affirm that the facts set forth in it are true and complete. I understand if I am accepted as a participant, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.	Yes No

	*Your Additional Information*

	Why do you want to participate in Housing America?
	What special skills do you have that we should know about?


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