Designated Appraiser Application | Royal Palm Coast Realtor Association®

SECTION I

Name of Applicant:*

Name of Company:*

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:

FL Appraiser License #:*

Name of the Office/Firm:*

Office Address*

Office Phone Number:*

Office Fax Number:

Office E-mail Address:*

Home Address
(Must Match license On DBPR)

Preferred Personal MLS Phone Number:*

Preferred MLS Fax Number:

Preferred Mailing Address*

Personal E-mail Address:*
please ensure this is a functioning email that you have access too

Your Position with the Business:*

Business Type:*

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 4 digits 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.*

Applicant Signature:*

Date of Signature:*

Only applicants for Designated REALTORS® or Secondary REALTORS® Membership who are principals, partners, or individuals in position of management control on behalf of individuals who are not physically present and engaged in the real estate profession in connection with the firm’s office location with the jurisdiction of the Association (e.g. branch office managers) must complete Section II.

Is the office address, as stated in Section I, your primary place of business?*

Yes
No

List the name and address of all branch offices or other firms in which you are a principal, partner, or corporate officer within the jurisdiction of the Association:

Office Name (1):

Office Address (1):

Office Name (2):

Office Address (2):

Office Name (3):

Office Address (3):

Have you previously been a member of another Association?*

Yes
No

If YES, which Associations?

What is your NRDS number?

Do you hold, or have you ever held, a license in another state?*

Yes
No

SECTION II

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 act, may be grounds for revocation of my membership if granted.

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.*

Applicant Signature:*

Date of Signature:*

SECTION III

Click the checkbox to agree to the following Statement of Responsibility: I assume full responsibility for accurate completion of this application form and do endorse this applicant as an individual who will be a credit to our trade association. Further, I will make every effort to see that this applicant fully complies with all regulations and requirements of the Florida Real Estate Commission and the Royal Palm Coast Realtor® Association.

Signature of Designated Appraiser:*

Date of Signature:*

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