By Tony West,2014-05-05 20:00
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    P. O. DRAWER H


    (252) 438-3550 Phone

    (252) 438-3852 Fax

Ms./Mrs./Mr.: Nickname:

    Type Membership: Affiliate Associate ? ?

    Social Security Number: Date of Birth:

    Are you actively engaged in real estate brokerage (selling and listing of real property)? YES NO ? ? Do you hold an active real estate or appraiser license? YES NO ? ?

     ?I hereby apply for Membership in the Kerr Lake Board of REALTORS, enclosing my check for initiation fees in the amount of

    $_____which is to be returned to me in the event of non-election. In the event of my election, I agree that I am in sympathy with the purposes and ideals of the association and that I will abide by the Constitutions and Bylaws and Rules and Regulations of the Kerr Lake Board of REALTORS?. I consent that the Association, through it’s Membership Committee or otherwise, may invite and

    receive information and comment about me from any Member or other person, and I further agree that any information and

    comment furnished to the Association by any person in response to the 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. I irrevocably waive all claims against the Association or any of its Officers, Directors, or Members, for any act in connection with the business of the Association and

    particularly as to its or their act in electing or failure to elect, advancing, suspending, expelling, or otherwise disciplining me as an Applicant, or as a Member.

     ?Only a person holding active REALTOR? Membership is entitled to use the term REALTOR or to ?wear or display the REALTOR symbol.

I hereby submit information for your consideration:

Company Name:

    Office Address:

     Address City State Zip Office Phone: Fax: Voice Mail:

Type of Business: Accountant Government Agency Mortgage Lender ? ? ?

    Advertiser Home Inspection Technology Provider ? ? ?

    Attorney Insurance Company Title Company ? ? ?

     ? Other (please specify):

    Home Address:

     Address City State Zip Home Phone: Fax: Cell Phone: E-mail Address: Website:

Preferred Mailing Address (check one): Office: Home:


    Have you ever held Membership in any REALTOR? Association? Yes No If so, where? From to

     (Name and Location) (Date) (Date) Did you leave in good standing? Yes No

    Are you now employed or engaged in any other business or profession? Yes No If so, please give position & location:

    Have you ever been convicted of a criminal offense other than minor traffic violations? Yes No If so, please give details:

I agree to pay the established dues (billed annually) as long as I am a member. Dues payments to the Kerr Lake Board of ?REALTORS are not tax deductible as charitable contributions. Portions of such payments may be tax deductible as ordinary and

    necessary business expenses. The portion of annual dues designated for lobbying expense is not allowable as a tax deduction. ALL FEES AND DUES ARE NON-REFUNDABLE.

By my signature, I certify that all statements herein are true and accurate, to the best of my knowledge.

Date Signature of Applicant


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