The Middletown Board
of REALTORS, Inc. Application for REALTOR
Membership Membership Type:
New ________
*Transfer ________
*Reinstatement ________ *Application fee does
not apply if reinstatement or transfer occurs within 2
years. Note to office
secretaries/office manager.
Only use top page of this application for Transfer or Reinstated
member. TO: The Middletown Board
of REALTORS, Inc. Board of
Directors. I,
hereby apply for
REALTOR Membership in
the above name Board, and enclose my check in the amount of $ ,
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 Orientation Class of the above
named Board, if any, other
wise on my own initiative to thoroughly familiarize myself with the
Code of Ethics and Arbitration Manual of the Board and
Constitution, bylaws, and Rules and Regulations of the above named Board,
the OHIO ASSOCIATION OF REALTORS, and the NATIONAL ASSOCIATION OF REALTORS
and I further agree that may act of pay dues shall evidence my initial and
continuing commitment to abide by the aforementioned Code of Ethics,
Constitution Bylaws, Rules and Regulations, and duty to arbitrate, all as
from time to time amended.
Finally, I consent that and authorize the Board, through its Board
of Directors 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 Board 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 if accepted as a member and he/she
subsequently resigns or it expelled from membership in the Board with an
ethics compliant or arbitration request pending, the Board of Directors
may condition renewal of membership upon applicants verification that
he/she will submit to the pending ethics or arbitration. s proceeding and
will abide by the decision of the Hearing Panel; or if applicant resigns
or is expelled from membership without having complied with an award in
arbitration, the Board of Directors may condition renewal of membership
upon his/her payment of the award, plus any costs that have been
previously been established as due and payable in relation thereto,
provided that the aware and such costs have not, in the interne, been
otherwise satisfied. I hereby submit the following
for your consideration: Name as shown on license:
_____________________________________________________________ License No. ______________ Type: Broker
_______
Salesperson ________ City:
_________________________________ State: _____________ Zip Code: ______________ Phone:
______________________________
Fax: ______________________________ City:
______________________________ State: _________________ Zip Code: _____________ Home Phone:
Date of
Birth
Date
Signature
State Position with
Firm: Principal ______
Partner _______
Corporate Officer ______
Trustee ______ Employee ______
Independent contractor _______
Other ______ If "other" please explain
__________________________________________________________________ Are you actively engaged in the real
estate business?
Yes _____
No _____
Yes _____
No ____ You are authorized to refer
to the following Middletown Board of Realtor members who know me: ___________________________________________________________________________________________________________________________ Name
Address
Phone ___________________________________________________________________________________________________________ Name
Address
Phone I agree that, if accepted for
Membership in the Board, I shall pay the fees and dues as from time to
time established. Date:
__________________
Signed:
________________________________________
(Applicants usual form
of
signature) Name as you want it to appear on
Middletown Board of REALTORS Roster: Last: ____________________ First (nickname optional):
________________________________ Phone Number:
________________________
Social Security
Number:____________________ Place of
Birth:
_________________________
Date of Birth:
_____________________________
City/County/State
Month/Day/Year Highest level of education
completed:
______________ First entered in the real estate business
_____________________ at
________________________
Month/day/
Year Have you been engage
continuously in the business since then? Yes _____ No
_____ If not, during what years
were you in the business?
__________ ____________________________________from ______
to ______, at ________________________ ____________________________________from ______
to ______, at ________________________ First licensed in the State of
Ohio _____________________________ Are you or have you previously been a member of any
other real estate board whether of not affiliated with the NATIONAL ASSOCIATION OF
REALTORS? Yes ______
No ______
Current Member ___________
Previous Member ____________ If so Name of Board, type of
membership held, and dates establishing the time periods for which
membership has been held
______________________________________________________________ Have you ever been refused membership
in any other real estate board?
Yes ____
No _____ Are you now employed or engaged in
any other business or profession? Yes ____
No _____ Do you hold, or
have you ever held, a real estate license in any other state? Yes ____
No _____ If "yes" , specify
_____________________________________ Has your real
estate license, in this or any other state, been suspended or
revoked? Yes___ No __ If "yes",
specify the place(s) and date(s) of such action, and detail the
circumstances relating thereto
*___________________________________________________________________________________ Have you ever
been convicted of a felony?
Yes _____ No ______ If "Yes",
please give 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. Signed ___________________________________________ Board use
only: Date accepted by Directors
____________________
Office Name: __________________________________________________________________
Residence Address:
____________________________________________________________________
Do you hold yourself out to the general public as being actively
engaged in the real estate business?
PERSONAL DATA
In what other business have you engaged?
In what phase of real estate do you specialize?
__________________________________________