Application for Multiple Listing Service Only

REALTOR® Membership Application

First Name *

Middle Name (or initial)

Last Name *

Email Address *

Real Estate License # *

If you do not have this number yet, enter a zero

Are you a licensed/certified Appraiser? *

If yes, please enter your Appraisal license #

Office Name *

Office Physical Address *

Office Physical Address City *

Office Physical Address State *

Office Physical Address ZIP Code *

Office Phone *

Member Physical Home Address *

Home Physical Address City *

Home Physical Address State *

Home Physical Address ZIP Code *

Direct Phone

Cell Phone *

Do you use a smartphone? *

If yes, which type?

Member Mailing Address *

Mailing City *

Please indicate your primary field of business *

Please indicate your secondary field of business

Please indicate your third field of business

Please indicate your fourth field of business

Mailing State *

Mailing ZIP Code *

Preferred Publication *

Preferred Phone *

Preferred Mailing *

Are you now a member of, or have you previously held membership in, another Association or Board of REALTORS®? *

If yes, what is the name of the Association?

Please enter your NRDS number *

How long have you been licensed with your current firm? *

Previous real estate firm, if applicable.

Number of years in the real estate business: *

Have you been found in violation of state real estate licensing regulations, civil rights or other laws prohibiting unprofessional conduct rendered by the courts or other lawful authorities within the last three years? *

If yes, please provide details.

Within the last ten years, have you been: 1) convicted of a crime punishable by death or imprisonment in excess of one year or, 2) been released from confinement imposed for that conviction? *

If yes, please provide details.

Have you been found in violation of the Code of Ethics or other membership duties in any Association of REALTORS® in the past three years? *

If yes, please provide details.

Are there pending ethics complaints against you? *

If yes, please provide details.

Do you have any unsatisfied discipline pending? *

If yes, please provide details.

Are you a party to a pending arbitration request? *

If yes, please provide details.

Do you have any unpaid arbitration awards or unpaid financial obligations to another association of REALTORS® or and Association MLS? *

If yes, please provide details.

If you are a principal, partner, corporate officer or branch manager you must complete the following information: If you are a principal, partner, corporate officer or branch manager you must complete the following information:

Your position?

Have you ever been refused membership in any other Association or Board of REALTORS®?

If yes, please provide details to include the name of the Association, circumstances and the basis for refusal.

Is the office address, as stated, your principal place of business?

Do you hold or have you ever held a real estate license in another state?

If so, where?

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 further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established. NOTE: Payments to the NORTHWEST ARKANSAS BOARD OF REALTORS® are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. NO REFUNDS. By clicking “I Agree”, I consent that the REALTOR® Associations (local, state, national) and their subsidiaries, if any (e.g., MLS, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Associations(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership. If accepted into membership, I agree to abide by the association bylaws, MLS and lockbox rules and regulations.

I Agree

Sending