Realtor Membership Application Form printable pdf download

REALTOR® MEMBERSHIP APPLICATION

To the Heartland REALTOR® Organization, I hereby apply for REALTOR® Membership in the Association and am enclosing my check in the amount of

$_______________ for Prorated National and State Dues* payable to the Heartland REALTOR® Organization. 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

Heartland REALTOR® Organization, the State Association and the National Association, and if required, I further agree to satisfactorily complete a reasonable and

nondiscriminatory 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 the timeframe established in the Association's bylaws (180 days from date of application). 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 Association 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®.

I hereby submit the following information for your consideration:

Name:__________________________________________________________________Date of Birth(Optional):___________________________________

Real Estate License #:_______________________________________________Social Security #:_______________________________________________

Residence Address:________________________________________________________________________________________________________________

Phone: __________________________________Fax:____________________________E-Mail: _________________________________________________

Licensed/certified appraiser: ____ Yes ____ No

Appraisal License #:______________________________________________________________________

Office Name:________________________________________________ Office Address:______________________________________________________

Phone:_______________________________________ Fax:________________________________E-mail:_________________________________________

Phone number to appear in MLS:____________________________________________________________________________________________________

Preferred Mailing: Home _____ Office_____

(List the location you would like all your mailings sent to, e.g: MLS/Association bills, NAR/IAR Publications)

Are you presently a member of any other Association of REALTORS®? ________ Yes _______ No If yes, name of Association and type of membership

held:_____________________________________________________ Number of years engaged in the real estate business:___________________________

Have you previously held membership in any other Association of REALTORS®? ______Yes _____ No

If yes, name of Association and type of membership held:______________________________________________________________________________

How long with current real estate firm? ___________________________ Previous real estate firm (if applicable): ______________ ____________

Specialty: ______ Residential _____ Commercial _____ Resort ______International _____ Other: ________________________________________________

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

APPLICATION FOR REALTOR® MEMBERSHIP: FOR DESIGNATED BROKERS/BRANCH MANAGERS

Company information: ____ Sole Proprietor ____ Partnership ____ Corporation ____ LLC (Limited Liability Company)

Your position: _____ Principal ____ Partner ____ Corporate Officer ______ 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: _______________

Realtor Membership Application Form

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