Type of Membership

1. I am applying for the following categories of membership (check all applicable boxes):

Designated REALTOR® (Broker of Record)

REALTOR® membership

MLS Subscriber (optional)

*** If applying for the following categories you must submit a Letter of Good Standing from your current Association.

Association Transfer

Secondary Designated REALTOR® Membership

Secondary REALTOR® Membership

General Information

2. Name (as it appears on your license)

Valid first name is required.

***Please note – we cannot use any name other than the name on your DRE license

3. First name

Valid first name is required.

Firm Broker of Record:

Valid first name is required.

4. Firm Address:

Valid last name is required.

5. Firm Telephone Number:

Valid first name is required.

Firm Fax Number:

Valid first name is required.

6. Home Address:

Please enter your shipping address.

7. Cell Phone Number:

Valid first name is required.

Personal Fax Number:

Valid first name is required.

8. Which address do you want listed as your primary mailing address?

Firm

Home

9. Driver’s License #

Birth date:

E-mail Address:

Web Site:

11. DRE License #:

Expiration Date:

NRDS #:

12. DRE License Type:

Broker

Salesperson

13. Primary Specialty:

Residential Brokerage

Property Management

Commercial/Industrial Brokerage

Appraising

Farm and Land Brokerage

Mortgage Financing

Building and Development

Other(s) (please specify):

14. List all REALTOR® Boards/Associations to which you CURRENTLY BELONG TO as a REALTOR® or MLS Subscriber:

15. List all REALTOR® Boards/Associations to which you PREVIOUSLY BELONGED TO as a REALTOR® or MLS Subscriber:

16. Have you ever been disciplined by any of the above Boards/Associations or MLSs in questions 14 & 15?

Yes (If yes, please attach copies of the discipline)

17. Are you currently being investigated or have you ever been disciplined by the DRE?

Yes (If yes, please attach copies of the discipline)

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REALTOR® Membership with MLS Application

Type of Membership

General Information