Home Address:
Cell Phone:
Pager:
Personal E-mail:
Business Address:
Business Phone:
Business Fax:
Business E-mail:

I hereby apply for Primary REALTOR® / Secondary REALTOR® / Designated REALTOR® in the above named Association, and enclose my check in the amount of $ , 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 of membership, to complete the indoctrination/orientation 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 to arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the Association and the Constitutions, Bylaws, and Rules and Regulations, and duty to arbitrate. I further agree to complete satisfactorily a reasonable and nondiscriminatory written examination covering such Code, Constitutions, Bylaws, Rules and Regulations, and duty to arbitrate as applicable. 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 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 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 findings 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 Association.

NOTE: Applicant further acknowledges that if accepted as a Member and he/she subsequently resigns or is expelled from membership in the Association with an ethics complaint or arbitration request pending, the Board of Directors may condition renewal of membership upon applicant’s verification that he/she will submit to the pending ethics or arbitration 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 previously been established as due and payable in relation thereto, provided that the award and such costs have not, in the interim, been otherwise satisfied.

Dues payments to the Association are not tax deductible as charitable contributions. Portions of such payments may be tax deductible as ordinary and necessary business expenses. Please consult your tax advisor.

Personal Data

I hereby submit the following information for your consideration: (Please print information)

Full Name as shown on License:
Name as you want it to appear on roster:
Nickname:
Gender: Male Female
Birth Date: / /
Social Security Number: / /
License #: Expires: / /

License Type:   Broker   Salesperson   Appraiser
  Other   (specify)

First licensed in this state on / / ,
and contiuously licensed since / /

Name of Firm:
Office Address:
Tax ID   Sole Proprietor   DBA     Partnership     Corporation

Position with Firm:

  Principal   Partner   Corporate Officer   Branch Office Manager
  Employee   Independent Contractor   Other   (specify)

State name of each Principal, Partner, Corporate Officer, or Trustee of the firm:
(Please supply names of Senior Partners or Officers first)
  
  

Y N   Do you or is any real estate firm in which you are a sole proprietor, general partner or corporate officer involved in any recent or 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? If “Yes”, specify the place(s) and date(s) of such action, and detail the circumstances relating thereto: (Attach separate sheet if necessary)

Y N   Have you ever been convicted of a felony? If “Yes”, give details including state and court of conviction: (Attach separate sheet if necessary)

Please indicate your area(s) of expertise and/or special interest: (Check all that apply)
  Finance   Fundraising   Communications   Dispute Resolution
  Education / Training   Marketing / PR   Meetings / Conventions   Technology

Professional Data

In what phases of Real Estate do you specialize?

Identify below any Professional Designations you hold: (Check all that apply)
  ABR   ALC   ARM   AMO   CAE   CCIM   CPM   CRB   CRS   CRE   CIPS   GAA   GRI   LTG   PRE   RAA   RCE   SIOR

Y N   Are you a member of an institute, society or council affiliated with the NATIONAL ASSOCIATION OF REALTORS®?
If “Yes”, please indicate name of affiliated institute, society, or council :

NOTE: An applicant for Institute Affiliate Membership shall supply to the Association evidence that the applicant holds a professional designation awarded by a qualified institute, society or council affiliated with the NATIONAL ASSOCIATION OF REALTORS® 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 Association, the State Association, and the National Association.

Y N   Are you actively engaged in the real estate business?
First entered the Real Estate business: / / , at Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Y N   Have you been engaged continuously in the business since then?
If “No”, during what years were you in the business?

Y N   Do you hold, or have you ever held, a real estate license in any other state?
If “Yes”, please specify name of state and license number :

Y N   Has your real estate license, in this or any other state, been suspended or revoked?
If “Yes”, specify the place(s) and date(s) of such action, and detail the circumstances relating thereto: (Attach separate sheet if necessary) :

Y N   Are there now any pending or unresolved complaints, or have there been within the past three (3) years, any complaints against you or the firm with which you have been associated before any state real estate regulatory agency or any other agency of government?
If “Yes”, specify the substance of each complaint in each state, the agency before which complaint was made, and the current status or resolution of such complaint: (Attach separate sheet if necessary) :

Y N   Are you now employed or engaged in any other business or profession?

Section II

This section must be completed by applicants for REALTOR® Membership, whether Primary or Secondary, who are PRINCIPALS, PARTNERS, CORPORATE OFFICERS, or BRANCH OFFICE MANAGERS (i.e. individuals in positions of management control on behalf of individuals who are not physically present and engaged in the real estate profession). All other applicants should proceed to SECTION III.

Section III

ALL Applicants must complete this section.

Association / Board Data

Y N   Are you CURRENTLY a member of another Board or Association which is affiliated with the NATIONAL ASSOCIATION OF REALTORS®, or HAVE YOU HELD membership in another Board or Association within the past four (4) years?
If “Yes”, list each Board/Association where membership was held, type of membership held, and approximate dates of membership: :

Y N   Did you have any unsatisfied debts (to include unpaid arbitration awards) or disciplinary action against you?

Y N   Have you taken a New Member Orientation Course?

If “Yes”, date: / /
(Please provide documentation of such for MCAR waiver)

Y N   Have you ever been REFUSED/EXPELLED from membership by any other Real Estate Association/Board?
If “Yes”, state basis for each such refusal and/or expulsion, and detail the circumstances related thereto: (Attach additional sheet(s) as needed)

Y N   Have you attended mandatory NAR Code of Ethics training within the past four (4) years?
Please indicate date and location of last Code of Ethics training completed / /

Y N   Do you have any pending ethics complaints (or Hearings) and/or pending Requests for Arbitration?
If “Yes”, please detail

Y N   Do you have record of violation of the Code of Ethics or other membership duties within the past three (3) years?
If “Yes”, please detail

Y N   Do you have an active SUPRA Lease Agreement or any other outstanding obligation with another Board/Association?
If “Yes”, please detail

Please forward completed application and payment to MCAR, 3031A Walton Rd, Ste 302, Plymouth Meeting, PA 19462

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 agree that, if accepted for membership in the Association, I will pay the fees and dues as from time to time established.

(Signature)

(Date)