"Application Form for Realtor and Broker Membership - Harford County Association of Realtors, Inc" - Harford County, Maryland

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HARFORD COUNTY ASSOCIATION OF REALTORS®, Inc.
APPLICATION FOR REALTOR® and BROKER MEMBERSHIP
All Applicants are required to complete and sign this application.
Return completed application to:
HARFORD COUNTY ASSOCIATION OF REALTORS®, INC.
P.O. Box 802, Bel Air, MD 21014-0802
Phone: 410-569-0750
FAX: 410-569-9654
Info@HarfordREALTORS.com
www.HarfordREALTORS.com
I hereby apply for Primary ___ Secondary ____
membership with the Harford County Association of REALTORS®.
COMPLETE ONLINE, PRINT CLEARLY, OR TYPE ALL INFORMATION
Prefix: ___Mr. ___ Mrs. ___Ms. ___Miss
Name as shown on your real estate license:
First Name: ___________________ Middle Name: _______________ Last Name:_________________
Suffix: _____________________________
Nickname: ______________________________________
Date of Birth: ________________________
License No._________________________ License Expiration Date: ___________________________
Name of Office:_______________________________________________________________________
Office Address: _______________________________________________________________________
Office Phone: ________________________ Office FAX: _____________________________________
Name of your Office Broker/Manager: _____________________________________________________
Home Address: ______________________________________________________________________
Home Phone: ________________________ Mobile Phone: __________________________________
Your Email Address: ___________________________________________________________________
License Type: Broker: ___ Associate Broker: _____ Salesperson:_____ Commercial: ____ Other:_____
Date you first entered the real estate business: _________________
_____________________
Date
State
List any current REALTOR® Designations held: _____________________________________________
List any other states where your license is active:____________________________________________
Has your real estate license ever been suspended or revoked? ___ YES ___ NO
Do you have any pending complaints with any REALTOR® association? ___ YES
____ NO
List REALTOR® Board/Associations where you held membership in the past three years or are
transferring from: _____________________________________________________________________
___________________________________________________________________________________
2015 REALTOR®/Broker Application
Page 1 of 3
HARFORD COUNTY ASSOCIATION OF REALTORS®, Inc.
APPLICATION FOR REALTOR® and BROKER MEMBERSHIP
All Applicants are required to complete and sign this application.
Return completed application to:
HARFORD COUNTY ASSOCIATION OF REALTORS®, INC.
P.O. Box 802, Bel Air, MD 21014-0802
Phone: 410-569-0750
FAX: 410-569-9654
Info@HarfordREALTORS.com
www.HarfordREALTORS.com
I hereby apply for Primary ___ Secondary ____
membership with the Harford County Association of REALTORS®.
COMPLETE ONLINE, PRINT CLEARLY, OR TYPE ALL INFORMATION
Prefix: ___Mr. ___ Mrs. ___Ms. ___Miss
Name as shown on your real estate license:
First Name: ___________________ Middle Name: _______________ Last Name:_________________
Suffix: _____________________________
Nickname: ______________________________________
Date of Birth: ________________________
License No._________________________ License Expiration Date: ___________________________
Name of Office:_______________________________________________________________________
Office Address: _______________________________________________________________________
Office Phone: ________________________ Office FAX: _____________________________________
Name of your Office Broker/Manager: _____________________________________________________
Home Address: ______________________________________________________________________
Home Phone: ________________________ Mobile Phone: __________________________________
Your Email Address: ___________________________________________________________________
License Type: Broker: ___ Associate Broker: _____ Salesperson:_____ Commercial: ____ Other:_____
Date you first entered the real estate business: _________________
_____________________
Date
State
List any current REALTOR® Designations held: _____________________________________________
List any other states where your license is active:____________________________________________
Has your real estate license ever been suspended or revoked? ___ YES ___ NO
Do you have any pending complaints with any REALTOR® association? ___ YES
____ NO
List REALTOR® Board/Associations where you held membership in the past three years or are
transferring from: _____________________________________________________________________
___________________________________________________________________________________
2015 REALTOR®/Broker Application
Page 1 of 3
HARFORD COUNTY ASSOCIATION OF REALTORS®, Inc.
I understand my payment, with the exception of the application fee, shall be returned to me in
the event I am not accepted to membership.
I understand that no portion of the payment is refundable after membership is accepted.
I agree as a condition to membership to complete the New Member Orientation Program
of the Harford County Association of REALTORS® within 90 days of this application, and
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 Constitution, Bylaws, and Rules and
Regulations of the Harford County Association of REALTORS®, the Maryland Association of
REALTORS®, and the National Association of REALTORS®. 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 as 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 all responses 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.
APPLICANT ACKNOWLEDGES as a member of Harford County Association of REALTORS®,
Inc., and by providing an email address, telephone number and fax number, applicant consents
to receive communications sent via email, telephone, or fax, by or on behalf of the Harford
County Association of REALTORS®
, the Maryland Association of REALTORS and the
National Association of REALTORS, including subsidiaries and affiliates of the respective
organizations. The Harford County Association of REALTORS®
will not share
email/telephone/fax information with any unaffiliated persons, companies or organizations.
APPLICANT ACKNOWLEDGES that the Association will maintain a membership file of
information which may be shared with other boards/associations/members and affiliate
members, where applicant subsequently seeks membership. This file shall include: name,
business address, business phone, email address, business web site, and 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 or its Multiple Listing Service.
APPLICANT ACKNOWLEDGES that if application is for transferring from another
REALTOR® Board or Association; or for a secondary membership with the Harford
County Association of REALTORS®, that applicant shall attach verification of completing
the required NAR® Code of Ethics course to this application for membership and a
statement from their current Board/Association affirming the member is in good standing
with no outstanding invoices.
*APPLICANT ACKNOWLEDGES that dues payments are not tax deductible as charitable contributions.
Contributions are not deductible for Federal income tax purposes. Contributions to RPAC are voluntary
and are used for political purposes. The amount indicated is merely a guideline and you may contribute
more or less than the suggested amount. The Association will not favor or disadvantage anyone by
reason of the amount of their contribution, and you may refuse to contribute without reprisal by the
Association. 70% of each contribution is used by the (State) PAC to support state and local political
candidates. The other 30% is sent to National RPAC to support Federal candidates and is charged
against your limits under 2 U.S.C. 441a. Contributions to the Harford County Association of
REALTORS® Charitable and Educational Foundation, a 501(c) 3 corporation, may be tax deductible.
2015 REALTOR®/Broker Application
Page 2 of 3
HARFORD COUNTY ASSOCIATION OF REALTORS®, Inc.
All Applicants must sign:
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, may be grounds for revocation of my membership, if granted.
Signed______________________________________________________________________
(Applicant)
(Date)
TO BE COMPLETED BY BROKER OR MANAGER (DESIGNATED REALTOR®):
I hereby verify that the above-named applicant is associated with my firm and I recommend that
the applicant be admitted to the Active membership in the Harford County Association of
REALTORS®, Inc. and I will comply with the dues formula rules of the National Association of
REALTORS®
Broker/Manager Name (please type or print clearly):___________________________________
Broker/Manager Signature: __________________________________ Date:_______________
Company: ___________________________________________________________________
Email: _______________________________________________________
Check or Money Order Payment:
Enclosed is $ ________ Dues ; and $ _______ *RPAC; and $ ___________ *HCAR Foundation
$ 0.00
Total Payment $_____________ MO/Check Number: _______________
Credit or Debit Card Payment:
_____Visa _____Master Card _____Discover _____ American Express
Name as it appears on the card ________________________________________________
Billing Zip Code ________________ Credit Card Number ____________________________
CVS____________________________ Expiration Date _____________________________
Signature__________________________________________________________________
SEND
PRINT
2015 REALTOR®/Broker Application
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