APPLICATION FOR REALTOR® MEMBERSHIP

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REALTORS® ASSOCIATION OF INDIAN RIVER COUNTY, INC.
2182 PONCE DE LEON CIRCLE, VERO BEACH, FL 32960
Phone (772) 567-3510 • Fax (772) 778-6490
e-mail Membership@rairc.com
Web http://www.RAIRC.com

I, ________ hereby apply for REALTOR® membership in the above named Association, which I understand will be returned to me in the event I am not accepted to membership. In the event my application is approved, I agree as a condition to membership to complete the indoctrination course of the above named Association, if any, and otherwise on my own initiative to thoroughly familiarize myself with the Code of Ethics of the NATIONAL ASSOCIATION OF REALTORS?, including the duty of arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the Association and the Constitutions, Bylaws, Rules and Regulations, of the above named Association, the State Association and the National Association, and I further agree to complete satisfactorily a reasonable and nondiscriminatory written examination covering such Code, Constitutions, Bylaws, Rules and Regulations, and duty to arbitrate. I further agree that my act of paying dues shall evidence my initial and continuing commitment to abide by the aforementioned Code of Ethics, Constitutions, Bylaws, Rules and Regulations, and duty to arbitrate, all as from time to time amended. Finally, I consent that and authorize the Association, through its Membership Committee or otherwise to invite and receive information and comment about me from any Member or other person, and I agree that any information and comment furnished to the Association by any Member or other person in response to any such invitation shall be conclusively deemed to be privileged and not form the basis of any action by me for slander, libel, or defamation of character.

NOTE: Applicant acknowledges that the board/association will maintain a membership file of information, which may be shared with other boards/associations where applicant subsequently seeks membership. This file shall include: previous applications for membership; all final finding of Code of Ethics violations and violations of other membership duties within the past three (3) years; pending complaints alleging violations of the Code of Ethics or alleging violations of other membership duties; incomplete or pending disciplinary measures; pending arbitration requests; and information related to unpaid arbitration awards or unpaid financial obligations to the board/association or its MLS.

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, that Board of Directors may condition renewal of membership upon applicant’s certification that he/she will submit to the pending ethics proceedings 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®.

Applicant also acknowledges that if he/she attends the indoctrination course and is accepted as a Member her/his Dues and Fees are non-refundable.

NOTE: Dues payments to the board/association are not tax deductible as charitable contributions. Portions of such payments may be tax deductible as ordinary and necessary business expenses.

I hereby submit

*Name as shown on License:

*Name as you want it to appear in the roster:

*Home Address:

*City/State/Zip:

*Resident at current address since:

Previous Residence:

*Primary Phone Number:

(xxx-xxx-xxxx):

Cell

Home

Other phone (xxx-xxx-xxxx):

*Email Address:

Web Site:

Birth Date:

*Sex:

Male

female

*Social Security #:

Title:

Mr.

Mrs.

Miss

Ms.

Nickname:

*Office Name:

Office Address:

*City/State/Zip:

*Office Phone (xxx-xxx-xxxx):

Direct Office Phone (xxx-xxx-xxx):

*What is your position in your office?:

*What is your current office status?:

*Is your current office address your principal place of business:

If not, please indicate and give addresses:

If you are a principal, partner or corporate officer, please answer the next 5 questions. Otherwise skip.

Does your office comply with zoning requirements for its location?:

Your Office is:

If office has a trade name please note::

State name of each other Principal, Partner, Corporate Officer or Trustee:

Name of Institution(s) in which you maintain your escrow or trustee account:

Are you or is any real estate firm in which you are a sole proprietor, general partner or corporate officer involved in any pending bankruptcy or insolvency proceeding or have you or any real estate firm in which you are a sole proprietor, general partner or corporate officer been

*adjudged bankrupt in the past three (3) years? :

NOTE: Applicant acknowledges that if the applicant or any real estate firm in which the applicant is sole proprietor, general partner, or corporate offices involved in any pending bankruptcy or insolvency proceedings or has been adjudged bankrupt in the past three (3) years, the board/association may require, as a condition of membership, that the applicant pay cash in advance for board/association and MLS fees for up to one (1) year from the date that membership is approved or from the date that the applicant is discharged from bankruptcy (whichever is later) or , ion the event that bankruptcy proceedings are initiated subsequent to obtaining membership in the board/association, that the member may be placed on a “cash basis” from the date that bankruptcy is initiated until one (1) year from the date that the member has been discharged from bankruptcy.

Agent License Number:

*Memeber Type:

License Expiration:

*NRDS #:

*Are you actively engaged in the real estate business?:

*Do you hold yourself out to the general public as being actively engaged?:

*Date Started In Real Estate:

Location:

Have you been engaged continuously in the business since then?:

If not, during what years were you in the business?:

How many years have you been active as Salesman?:

How many years have you been active as Broker? :

Date or year first licensed in this state:

Continuously licensed in this state since then?:

Date started with present firm:

Do you hold, or have you ever held, a real estate license in any other state?:

If yes, specifiy:

*Has your real estate license, in this or any other state, ever been suspended or revoked?:

If yes, specify the place(s) and date(s) of such action, and detail the circumstances relating thereto:

*Within the past five years have there been any complaints against you, or any firm with which you have been associated, before any state real estate regulatory agency or any other government agency?:

If yes, specify the substance of each complaint, the agency and location before which complaint was made, and the current status or resolution of such complaint::

*Have you ever been convicted of a felony? :

If yes, give details:

*Have you ever held membership with a real estate Association or Board?:

If yes, name each one, type of membership held, and the time period for which membership was held:

Recent Association committee experience:

*Have you ever been refused membership in any other real estate Association or Board?:

If yes, state basis for each such refusal and detail the circumstances related thereto:

*Have you ever participated in a Multiple Listing Service? :

If yes, where?:

What designations do you hold, i.e., GRI, CRS, CRB, CCIM:

*Please indicate the top three areas of importance to you:

NOTE: An applicant of Institute Affiliate Membership shall supply to the Membership committee evidence that applicant holds a professional designation awarded by a qualified institute, society or council affiliated with the NATIONAL ASSOCIATION OF REALTORS^Ò that addresses a specialty area other than residential brokerage or who otherwise holds a class of membership in such institute, society or council that confers the right to vote or hold office and shall agree, if elected to membership, to abide by the constitution, bylaws and rules and regulations of the local board, the state association, and the National Association.

*Are you now employed or engaged in any other business or profession?:

If yes, please give position and location:

In what other business have you been engaged? (provide to and from dates):

*You are authorized to refer to the following members of this Association who know me (provide names and contact info):

Personal and Credit References

*Bank:

Others:

Applicants for REALTOR^® membership in the Association who are required by the Association Bylaws to attend and successfully complete a course of instruction otherwise known as Orientation are required to attend that course within a period of ninety (90) days from the date of their application for membership.

All new member applicants are required to attend courses on the following subject matters: Local, State and National Associations, Ethics & Professional Standards, Antitrust, and Fair Housing. All applicants are required to attend and pass the final exam, the content, which is based only on the required subject matter.

Failure to comply with this ruling will result in the applicant being dropped from consideration by the Association. Reapplication to the Association will require payment to the Association of new application fee in the amount equal to the original fee. Exceptions will be considered on an individual basis by the Board of Directors upon request of the applicant.

I agree that, if accepted for Membership in the Association, I shall pay the fees and dues as from time to time established. All dues and fees are non-refundable once approved for membership.

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.

*E-Signature:

Signed:

Date:

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