Realtor Membership Application Form Page 2
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_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Have you or your 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
Association, I shall pay the fees and dues as from time to time established. NOTE: Payments to the Heartland REALTOR® Organization 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 and 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: _______________________________________________________________________________
PLEASE SUBMIT APPROPRIATE FEES WITH APPLICATION
NOTE: There is a $100 application fee for new applying members when applying for application.
There is No
application fee for Transferring REALTOR® members.
Month
National
National
IAR
IAR
Local Dues
Sub-Totals
RPAC
Total
Dues
Public
Dues
Advocacy
(Voluntary)
Awareness
Initiative
400.00
432.00
January
120.00
35.00
170.00
75.00
0.00
32.00
February
110.00
35.00
155.87
75.00
0.00
375.87
32.00
407.87
351.70
383.70
March
100.00
35.00
141.70
75.00
0.00
32.00
327.53
359.53
April
90.00
35.00
127.53
75.00
0.00
32.00
May
80.00
35.00
113.36
75.00
0.00
303.36
32.00
335.36
279.19
311.19
June
70.00
35.00
99.19
75.00
0.00
32.00
July
60.00
35.00
85.02
75.00
0.00
255.02
32.00
287.02
230.85
262.85
August
50.00
35.00
70.85
75.00
0.00
32.00
September
40.00
35.00
56.68
75.00
0.00
206.68
32.00
238.68
182.51
214.51
October
30.00
35.00
42.51
75.00
0.00
32.00
November
20.00
35.00
28.34
75.00
0.00
158.34
32.00
190.34
134.17
166.17
December
10.00
35.00
14.17
75.00
0.00
32.00
RPAC – REALTORS® Political Action Committee
RPAC Contributions, either state or federal, are not deductible as charitable contributions for federal income tax purposes. Contributions to RPAC
are voluntary. Refusal to contribute does not affect membership rights. All personal contributions will be credited to the IAR Federal PAC and will be
charged against your contribution limits under 2U.S.C.441a. All other contributions will be credited to Illinois RPAC. Copies of reports for Illinois
RPAC are filed with the State Board of Elections and are (or will be) available for purchase from the State Board of Elections, Springfield, Illinois.
Revised 06/16
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