Agent | Royal Palm Coast Realtor Association®

Name of Applicant:*

Name of Brokerage:*

Type of Membership:*

Click the checkbox to agree to the following: In the event my application is approved, I agree as a condition of membership to complete the orientation course of the above named Association, 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, Constitutions, Bylaws, and Rules of Regulations of the above named Association, and State Association and the National Association. 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 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 I agree that any information and comment furnished to the Association by a Member or other person in response to any such invitation shall me conclusively deemed to be privileged and not form the basis of any action by me for slander, libel, or defamation of character. NOTE: Applicant acknowledges that if accepted as a Member and he/she subsequently resigns or is expelled from membership in the Association 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 in arbitration, the Board of Directors may condition renewal of membership upon his/her payment of the award, plus any costs that have previously been established as due and payable in relation thereto, provided that the award and such costs have not, in the interim been otherwise satisfied.*

I hereby submit the following information for your consideration:

Name as it appears on License:*

Nickname:

Florida Real Estate License #:*

Name of the Brokerage Office:

Office Address*

Office Phone Number:*

Home Address
Must match the address listed on FL Real Estate License.

Preferred Personal MLS Phone Number:*

Have you ever held a real estate license in another state?*

Yes
No

Have you EVER been a member with the Royal Palm Coast Realtor® Association OR any other REALTOR® Association at any time?*

Yes
No

If yes, what Association are you or were you a member of?

If you know your NRDS/M1 number, please enter here:

Preferred Mailing Address:

E-mail Address:*
Please make sure this is a functioning email that you have access to.

Click the checkbox to agree to the following: I agree that, if accepted for Membership in the Association, I shall pay the fees and dues as from time to time established. By signing below, I understand that dues are not refundable. If paid via credit card, I authorize my card ending in the last 4 digits listed below to be used for a one-time payment.*

Last 4 digits of credit card:*
You will be asked to provide this full credit card number at the time of application processing. Please make sure it is available for use when ready to make payment for membership. Charges may appear on your statement as REALTOR ASSN/CHICAGO IL.

Click the checkbox to agree to the following: By typing my name below, I understand that this serves as my electronic signature and confirms my agreement to this application.*

Signature:*

Date of Signature:*

Please enter the email that you would like a copy of this application sent to:

Agent Application

Agent Application