Application Form For Affiliate Membership
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1
2FOR OFFICE USE ONLY
Member # _______________________
Office # _____________ MLS Y/N
Amt Paid $_______Rvwd by ________
Application for Affiliate Membership
First Name ______________________________ Last Name ______________________ Middle Name _________________
Home Address _______________________________________________________________________________________
City ___________________________________________________ State ___________ Zip _________________________
Office Name _________________________________________________________________________________________
Office Address _______________________________________________________________________________________
City ___________________________________________________ State ___________ Zip _________________________
Office Phone ____________________________________________ Home Phone _________________________________
Fax Number ____________________________________________ Date of Birth (Month/Day/Year) __________________
Preferred Email Address (required) ______________________________________ DUES BILLED ANNUALLY BY EMAIL ONLY
Service Provided: (check one)
o Appraisers
o Marketing
o Attorney
o Mortgage Co.
o Closers
o Photography
o Consultants
o Property Managers
o Government Agencies
o Publications
o Home Inspectors
o Title Companies
o Insurance
o Other, please specify
o I wish to register for a Supra Key
*Qualified Key Holders – Affiliate members of the Association who are not licensed by the state of Minnesota, will
require satisfactory completion of a criminal background check.
Total Enclosed $ _____________ Applicant Signature _____________________________________ Date _____________
(Over - complete reverse side )
5750 Lincoln Drive • Minneapolis, MN 55436 • 952.933.9020 phone • 952.933.9021 fax •
Revised July 13, 2015
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Parent category: Legal