REALTORS® Association of Lincoln
AFFILIATE MEMBERSHIP APPLICATION

Fill out form completely, then print and submit to the address at bottom of form. If you want to print a blank form, go here. If you have any questions about this application, they should be directed to Christie Haynes, Operations Manager, REALTORS® Association of Lincoln (402-441-3623).
Required fields are indicated by *.
*First Name:
Middle Name:
*Last Name:
*Birthdate: ( mm-dd-yy )
*Social Security #:
*Drivers License #: State:
*Name of Business:
*Business Address:
(as would like it to appear)
*Business Phone:
 Business Fax:
Personal E-mail:
Company Website:
Previous Employment:
(if less than 2 yrs at current business)
*Residence Address:
*Residence Since (year):
format (yyyy)
*Do you presently have any charges pending against you, or have you ever been convicted of a felony or misdemeanor, other then a traffic violation?       Yes No
If yes, give details: *Only visible text will print*
*Are you a licensed Real Estate Broker, Salesperson, or Appraiser in Nebraska?:       Yes No
Is the license presently active?:       Yes No
If yes, location of license:
*Are you currently involved in buying, selling, exchanging or subdividing real estate?       Yes No
*Have you ever been refused membership in any other Real Estate Board?:       Yes No
If yes, state basis for each refusal, and detail the circumstances related thereto: *Only visible text will print*
*State you reason(s) for seeking affiliate membership in the REALTORS® Association of Lincoln: *Only visible text will print*

I acknowledge that all information contained in this application is true and correct to the best of my knowledge. I hereby apply for Affiliate Membership in the REALTORS® Association of Lincoln, enclosing payment in the amount of $ (see details below) which I understand will be refunded in the event I am not elected to membership.

I agree, if elected to Affiliate Membership, to abide by the Articles of Incorporation, Bylaws, Rules and Regulations of the REALTORS® Association of Lincoln and to pay all dues and fees as may be established from time to time. Should a lockbox system key be issued, Affiliate Member agrees to abide by the bylaws, rules and regulations of Midlands MLS, Inc.

I irrevocably waive all claims against the REALTORS® Association of Lincoln 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 acts in electing or failure to elect, advancing, suspending, expelling, or otherwise disciplining me as an applicant, or as a member. Upon the expiration of said membership for any cause, I will return to the Association all certificates, signs, seals, or other indications of membership in the Association.
DATE: SIGNATURE: ______________________________
Annual REALTORS® Association of Lincoln Affiliate Dues:
(from October 1 through September 30)		 $

*******************************************
FOR OFFICE USE ONLY:
REALTORS® Association of Lincoln Prorated Dues: $
Application Fee: (one time only) $
TOTAL DUE:
Make payable to "RAL"		 $
Please contact me regarding the lease of an electronic key for use with the Midlands MLS keybox system. (optional service)


Submit Completed Application to:
REALTORS® Association of Lincoln
8231 Beechwood Dr.
Lincoln, NE. 68510