Application for Realtor Membership

DUES AND APPLICATION FEES ARE NOT REFUNDABLE

* Name:

Name as you want it to appear in the roster:

* Office Affiliation:

* Home Address:

* Home City:

* Home Zip:

Date of birth:

Social Sec #:

This field is not required online. You may wait to give your SSN upon visiting LBAR's office.

* Home Phone:

* Real Est License number:

E-mail address:

Web Page address:

Voice mail:

Cell Phone:

Have you been or are you currently a member of any other real estate association:

If "yes", name the Association, type of membership held, and the time period for which membership has been held.:

If "yes", please enter your NRDS number (National Realtor Data System number).:

* Are you aware that your services will be suspended if you fail to complete the (15) hours of required orientation classes within 120 days of joining?:

	yes
	no

* If you should at any point leave your current broker, your services will be suspended until you place your license with another LBAR member broker. Are you aware of this?:

	yes
	no

* I have read the orientation/education requirements.:

	yes
	no

The orientation/education requirements are available by visiting http://www.lbar.com/realtor.htm.