REALTORS® Association of Lincoln
REALTOR® / APPRAISER 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 *.
I. Individual Information
*First Name:
Middle Name:
*Last Name:
*Birthdate: ( mm-dd-yy )
*Home Address :
*City : *State: *Zip
*Social Security #:
*Driver's License #: *State:
*Broker License #:
*Salesperson License #:
*Appraiser License #: Registered
Certified-Residential 		Licensed
Certified-General
II. Office Information
*Real Estate Office:
*MLS Participant?:     Yes No
*Office Address:
Suite #:
*City:
*State:
*Zip:
*New MLS Office?:     Yes No
III. Contact Information      (Phone number format: nnn-nnnn, or nnn-nnn-nnnn)
*Office Phone: Office Fax:
Office Desk Phone: Residence Phone:
Cell Phone: Pager:
Personal E-mail:
Personal Web Site:
Personal Fax:
IV. Professional History
*1. Do you hold, or have you ever held, a real estate license in any other state?     Yes No
If "yes", specify state(s): Note: Only visible text will print.
*2. Are you a member of, or have you previously held, membership in any other REALTOR® association?     Yes No
If "yes", give name(s) of each association, type(s) of membership held, and dates of membership: Note: Only visible text will print.
*3. Has your real estate, or appraiser license in this state, or any other state, been suspended, or revoked, or is a proceeding concerning your license now pending?     Yes No
If "yes", give explanation: Note: Only visible text will print.
*4. Is there now, or have there been within the last three years any complaints against you with any city, state or federal regulatory agency?     Yes No
If "yes", explain: Note: Only visible text will print.
*5. Have you been involved in any unprofessional conduct in the past three years, such as violations of civil rights laws, real estate license laws, or findings of violations of the REALTOR® Code of Ethics?     Yes No
If "yes", explain: Note: Only visible text will print.
V. For principals, partners, corporate officers or designated office brokers only:
1. What is your firm's structure?
Sole Proprietorship Partnership Corporation
If not a sole proprietorship, give the names and titles of all principals and corporate officers: Note: Only visible text will print.
2. Is the office address stated in Section II, your principal place of business?     Yes No
If "no", give business address:
3. Have you ever been
convicted of a felony?		     Yes No
If "yes", explain. Include state and court of conviction: Note: Only visible text will print.
VI. Computation of Dues, Fees and Deposits:

The payment made with this application includes: (1) a one-time application fee of $275.00; (2) an MLS firm fee (for new MLS offices) of $1,250.00; and (3) a prorated dues payment for the current year. Local dues are prorated from the first day of each month; based on a fiscal year of October 1 through September 30. State and national dues are prorated from the first day of each month, based on a fiscal year of January 1 through December 31.

Annual dues for 2012 are $575 ($200 local + $220 state + $155 national)

ATTENTION: In addition to the amount paid with this application, annual dues will be billed to all members in July of each year. Dues must be paid before August 31, to avoid a $50 late penalty. Members with unpaid dues on October 1 will be terminated. If applying for membership on or after August 1, 2012 prorated dues for 2012 and 2013 dues will be collected together.

   
Individual member application fee: $ (one time fee)
REALTOR® Dues (prorated): RAL $
  NRA $
  NAR $
New MLS Firm Fee: $
*TOTAL DUE WITH APPLICATION: $ - Make Payment Payable to "RAL"

**If you choose to hold a Lockbox Key a payment to "Supra Products" will also be collected at the time of joining. When you come in to join, staff will discuss your options regarding the Supra Lockbox system.
VII. Authorization for payment of MLS fees.
I authorize Midlands MLS (MMLS) to debit my checking/savings account monthly for participant/subscriber fees and any optional services that I authorize. I understand the fees will vary from time to time as set by the Board of Directors and that this form is valid as long as I am a participant/subscriber of MMLS.
Debit my:  
  Checking account - attach copy of voided check.
  Savings account - attach copy of deposit slip.
Name as it appears on account:
Signature: _______________________________________________________
To avoid service interruption, please notify MMLS of any changes in your account information. MMLS charges will be debited on the first business day of each month.
Current charges: $ per month for subscribers (Agents).
  $ per month for participants (Designated REALTORS®).
VIII. Certification:

I certify that the above information is true and correct and that failure to provide complete information as requested or any misstatement of fact shall be grounds for denial of membership or revocation of my membership.

I understand that I shall be granted provisional membership immediately upon submission of a completed application form and remittance of applicable Association dues and any application fee, which will be returned to me in the event I am not accepted to membership. As a provisional member, I shall be considered a REALTOR® and shall be subject to all of the same privileges and obligations of membership including a commitment to abide by the Code of Ethics, the Bylaws and Rules of the REALTORS® Association of Lincoln and Midlands MLS. I understand that the temporary status created by membership is granted subject to subsequent review of the application in accordance with Association Bylaws. If the Board of Directors determines that I do not satisfy all of the requirements of membership such as the completion of a mandatory orientation program, membership may at the discretion of the Board of Directors, be terminated. I understand that when all of the requirements for membership have been satisfied, the Provisional membership status shall automatically become permanent REALTOR® membership.

I also authorize the Association to invite and receive information and comment about me from any Member or other person. I agree that an information and comment about me from any Member or other person in response to any such invitation shall be conclusively deemed to be privileged and not form the basis on any action by me for slander, libel, or defamation of character.

By establishing membership you agreed to be contacted by the REALTORS® Association of Lincoln by telephone, fax, email and all other electronic means.

Note: Applicant acknowledges that if accepted to membership and he/she subsequently resigns or is expelled from membership with an ethics complaint or arbitration request pending, the Board of Directors may condition renewal of membership upon applicant's verification that he/she will submit to the pending ethics or arbitration proceeding and will abide by the decision of the Hearing Panel; or if applicant resigns or is expelled from membership without having complied with an award, plus any costs that have been established previously as due and payable in relation thereto, provided that the award and such costs have not, in the interim, been otherwise satisfied.

 
Date:
Applicant's Signature: __________________________________________________________________

 

 


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