Oct. '07 NRDS Work Group Report -- Appendix D
(Note: There will be a template for REALTOR, REALTOR ASSOCIATE, as well as one for those associations who use Provisional membership)
To the [Name] Board of REALTORS®, I hereby apply for REALTOR® Membership in the above named Board and am enclosing my check payment in the amount of $ [application fee]for a one time application fee and $ [yearly dues amount] * for my [year] Dues payable to [Board Name]. My application fee and [year] dues will be returned to me in the event of non-election. Application fee is nonrefundable. I will attend orientation within [ ] days of Association’s confirmation of provisional membership. Failure to meet this requirement may result in having my membership terminated. In the event of my election, I agree to abide by the Code of Ethics of the National Association of REALTORS®, which includes the duty to arbitrate, and the Constitution, Bylaws and Rules and Regulations of the above named Board, the State Association and the National Association, and if required, I further agree to satisfactorily complete a reasonable and non-discriminatory written examination on such Code, Constitutions, Bylaws and Rules and Regulations. I understand membership brings certain privileges and obligations that require compliance. Membership is final only upon approval by the Board of Directors and may be revoked should completion of requirements, such as orientation, not be completed within timeframe established in the association’s bylaws. I understand that I will be required to complete periodic Code of Ethics training as specified in the association’s bylaws as a continued condition of membership.
NOTE:Applicant acknowledges that if accepted as a member and he/she subsequently resigns from the Board or otherwise causes membership to terminate with an ethics complaint pending, the Board of Directors may condition renewal of membership upon applicant’s certification that he/she will submit to the pending ethics proceeding and will abide by the decision of the hearing panel. If applicant resigns or otherwise causes membership to terminate, the duty to submit to arbitration continues in effect even after membership lapses or is terminated, provided the dispute arose while applicant was a REALTOR®.
Amount shown is prorated according to month joining. I hereby submit the following information for your consideration:
First Name Middle Name Last Name Suffix (Jr, III, Sr, etc)
Nickname (DBA)
Name: ______________________________________________________ Nickname: ____________
Email Address: ______________
Real Estate License #: _________________________________________
Licensed/certified appraiser: [ ] Yes [ ] No Appraisal License #: __________________________
Office Name: _________________________________________________________________________
Office Address: _______________________________________________________________________
OfficePhone:__________________ Office Fax:_____________________
Resident Home Address: Street City State Zip_______
Home Phone: __________________ Personal Fax: _____________________ Home E-Mail: ____________
Cell Phone: __________________ Preferred Publication Mailing: [] Home [] Office Street Office Mail Alternate [] Member Mail Alternate []
Preferred Phone: []Home [] Office [] Cell
Are you presently a member of any other Association of REALTORS®? [ ] Yes [ ] No
If yes, name of Association and type of membership held: _____________________________________________________
Have you previously held membership in any other Association of REALTORS®? [ ] Yes [ ] No
If yes, name of Association and type of membership held: _____________________________________________________
Have you been found in violation of the Code of Ethics or other membership duties in any Association of REALTORS® in the past three (3) years or are there any such complaints pending? [ ] Yes [ ] No (If yes, provide details as an attachment.)
If you are now or have ever been a REALTOR®, indicate your NAR membership (NRDS) #: _________________________ and last date (year) of completion of NAR’s Code of Ethics training requirement: _______.
Are you a principal, partner, corporate officer or branch office manager? [ ] Yes [ ] No If yes, you must also complete 2ndpage of this application.
I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established. NOTE: Payments to the [Name] Board of REALTORS® are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. No refunds. In the event I fail to maintain eligibility for membership, or discontinue membership, I understand I will not be entitled to a refund of dues and fees for any reason.
By signing below I consent that the REALTOR® Associations (local, state, national) and their subsidiaries, if any (e.g., MLS, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Association(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership.
Dated: Signature:
(Optional Information): Date of Birth: _________________
Specialty: [ ] Residential [ ] Commercial [ ] Resort [ ] International [ ] Other: _____________________
How long with current real estate firm? _______
Previous real estate firm (if applicable): ____________________________
Number of years engaged in the real estate business: ___________
Field of Business (Specialties): please click the link to view all specialties to select
Languages spoken: please click the link to view all languages to select
APPLICATION FOR REALTOR® MEMBERSHIP: PAGE 2 FOR IF YOU ARE A DESIGNATED BROKERS/BRANCH MANAGERS, YOU MUST ALSO COMPLETE PART 2 OF THIS APPLICATION
Company information: Sole Proprietor Partnership Corporation LLC(Limited Liability Company)
Other, specify __________________________________________
Your position: Principal Partner Corporate Officer Majority Shareholder Branch Office Manager
Names of other Partners/Officers/ of your firm: _______________________________________________________________________________________
Have you ever been refused membership in any other Association of REALTORS®? [ ] Yes [ ] No
If yes, state the basis for each such refusal and detail the circumstances related thereto: _______________________________________________________________________________________
Is the Office Address, as stated, your principal place of business? [ ] Yes [ ] No
If not, or if you have any branch offices, please indicate and give address: _______________________________________________________________________________________
Do you hold, or have you ever held, a real estate license in any other state? [ ] Yes [ ] No
If so, where: _______________________________________________________________________________________
Have you or your firm been found in violation of state real estate licensing regulations within the last three years? If yes, provide details: _______________________________________________________________________________________
Have you or you firm been convicted, adjudged, or otherwise recorded as guilty by a final judgment of any court of competent jurisdiction of a felony or other crime. If yes, provide details: _______________________________________________________________________________________
I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established. NOTE: Payments to the [Name] Board of REALTORS® are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. No refunds.
By signing below I consent that the REALTOR® Associations (local, state, national) and their subsidiaries, if any (e.g., MLS, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Association(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership.
Dated: Signature:
Information to be supplied by local association:
Join Date:
Status: Active, Provisional
Primary Local Association NRDS ID:
Primary State Association NRDS ID:
Office ID:
(if broker)
Office Contact DR:
Office Contact Manager:
Number of Non-Member Licensees:
