Please See Last Page for Pricing Information

MEMBERSHIP/PARTICIPATION APPLICATION

I, _________________________________, hereby apply for the following type of membership in the LAKE COUNTRY BOARD OF REALTORS®, INC.

____ PRIMARY REALTOR® ____ SECONDARY REALTOR® ____ APPRAISER ____ MLS ONLY PARTICIPANT

PLEASE SEE LAST PAGE FOR PRICING INFORMATION

Enclosed is my check in the amount of $________, which I understand will be returned to me in the event I am not accepted to membership. In the event my application is approved, I understand that my fees are non-refundable and I agree as a condition of membership to thoroughly familiarize myself with the CODE OF ETHICS of the National Association of REALTORS®, its Constitution, Bylaws, and Rules and Regulation of the Local, State and National Associations/Boards. As a REALTOR® member will abide by the Code of Ethics of the National Association specified by Article 17, of the Code of Ethics, and as further specified in the Code of Ethics and Arbitration Manual of the National Association of REALTORS® and as from time to time amendments and (2) that I consent that the Board, through its Membership Committee or otherwise, may invite and receive information and comments about applicants from any member or other person, and that I agree that any information and comment furnished to the Association/Board by any person in response to the invitation shall be conclusively deemed to be privileged and not form the basis of any action 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/Board with an ethics complaint or arbitration request pending, the Association/Board may condition renewal of membership upon applicant’s verification that he/she will submit to the pending ethics by 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 cost that have previously been established due and payable in relation thereto, provided that the award and such costs have not, in the interim been otherwise satisfied.

I hereby certify that I have read and understood the above statements and that, if accepted, I shall pay the fees and dues as from time to time established and that the following information furnished by me for your consideration and use in true and correct. I further agree that the failure to provide complete and accurate information as requested, on any misstatement of fact, shall be grounds for revocation of my membership if granted.

I Authorize LCBOR to fax and email information concerning my membership and participation in the BOARD AND MLS.

SIGNATURE:_____________________________________DATE:_______________________

APPLICATION FOR MEMBERSHIP OR PARTICIPATION

PERSONAL INFORMATION: ALL INFORMATION REQUIRED.

NAME ON LICENSE:______________________________________________________________________

NAME ON ROSTER: _______________________________ NICKNAME:_____________________________

HOME ADDRESS:____________________________CITY: ______________ STATE:____ZIPCODE:________

PHONE: __________________ CELL: ___________________ FAX:_____________________

CONTACT PHONE PREFERRED: OFFICE___ HOME___ CELL ___

EMAIL ADDRESS:_________________________________________________________________________

PERSONAL WEBSITE:______________________________________________________________________

SOCIAL SECURITY NO:__________________________ DATE OF BIRTH:______________________

(last four numbers)

MOTHER’S MAIDEN NAME:_________________________ SPOUSE’S NAME:_________________________

EDUCATION: HIGH SCHOOL____ COLLEGE ______ DEGREE(S) _____________________________

LANGUAGE(S): __________________________________________________________________________

HOBBIES/SPECIAL INTEREST:_______________________________________________________________

PROFESSIONAL BACKGROUND:________________________________________________________

PLEASE LIST ALL PROFESSIONAL/CIVIC ORGANIZATIONS THAT YOU PARTICIPATE IN AND POSITION THAT YOU HOLD (CHAIR, DIRECTOR, PTO, COMMERCE, ETC.)________________________________________________

_________________________________________________________________________________________

MAILING ADDRESS PREFERENCE: OFFICE____ HOME____ P.O. BOX _____ APT.______

P.O. BOX____________________ APT.#________________________

CITY:_____________________________________ STATE ____________ ZIPCODE:__________________

DO YOU HOLD ANY REALTOR® DESIGNATIONS? ____YES ____NO LIST:________________________

COMPANY INFORMATION: ALL INFORMATION REQUIRED.

Do you have a current real estate/Appraiser license in Georgia? Yes____ No ____ If yes, please provide the following information: COPY OF REAL ESTATE LICENSE POCKET CARD.

Date Issued:___________ License No.:_________ Type License __ Salesperson ___Brokers ___Appraiser

First Licensed in Georgia: (mm/dd/year) _________ Date established with Firm (mm/dd/year)____________

NAME OF FIRM:_________________________________________________________________________

COMPANY ADDRESS:__________________________________________________________________

PHONE:__________________FAX:________________ CO. LICENSE #____________________________

COMPANY WEBSITE:___________________________________________________________________

Do you hold or have you held a real estate license in any other state? ___yes ___No (If so, specify, state and date): ___________________________________________________________________________________

Has your real estate license, in this or any other state been suspended, or revoked?

_____Yes ____No If yes, State ________________

Do you now or have you previously held membership in any other Association? ___Yes ____No

If yes, Name of Association and type membership and dates___________________________________

Have you ever been refused membership in any other Association? ____Yes ___No. If yes state a basis for each refusal and circumstances related (attach)

Is the office address, as stated your principal place of business? ___Yes ___No

Have you ever been convicted of a felony? ___Yes ___No (If yes give details. Attach separate page).

Paragon: if you have a preferred Login and Password, please list or one will be assigned:

LOGIN:__________________ PASSWORD:_______________________

IF YOUR LICENSE HAS BEEN ON INACTIVE STATUS FOR MORE THAN THREE MONTHS, PLEASE SUBMIT A COPY OF BACKGROUND CHECK. IF YOU HAVE BEEN A MEMBER OF ANOTHER BOARD/ASSOCIATION PLEASE GET A LETTER STATING ANY OUTSTANDING DEBTS AND/OR COMPLAINTS IN THE PAST 3 YEARS. PROVIDE DATE THAT CODE OF ETHICS WAS TAKEN.

2016 PRICING INFORMATION

PRIMARY & APPRAISER MEMBERSHIP:

$510 FOR JAN-DEC. IF JOINING IN ANY MONTH OTHER THAN JANUARY, PLEASE MULTIPLY $74.59 BY HOW MANY MONTHS REMAIN IN THE YEAR. YOU MUST INLCUDE FROM THE DATE YOU BECAME ACTIVE WITH YOUR CURRENT BROKER, NOT THE DATE YOU ARE FILING YOUR APPLICATION. PLEASE INCLUDE AN APPLICATION FEE OF $75.

**FOR BROKERS ONLY: ALL AGENTS IN YOUR OFFICE MUST JOIN. YOUR ONE-TIME FEE FOR JOINING THE BOARD IS $700 AND YOUR ONE-TIME FEE FOR JOINING THE MLS IS $600. THIS IS IN ADDITION TO THE DUES ABOVE.

SECONDARY & APPRAISER MEMBERSHIP:

$257 FOR JAN-DEC. IF JOINING IN ANY MONTH OTHER THAN JANUARY, PLEASE MULTIPLY $21.42 BY HOW MANY MONTHS REMAIN IN THE YEAR. YOU MUST INLCUDE FROM THE DATE YOU BECAME ACTIVE WITH YOUR CURRENT BROKER, NOT THE DATE YOU ARE FILING YOUR APPLICATION. PLEASE INCLUDE AN APPLICATION FEE OF $75.

**FOR BROKERS ONLY: ALL AGENTS IN YOUR OFFICE MUST JOIN. YOUR ONE-TIME FEE FOR JOINING THE BOARD IS $700 AND YOUR ONE-TIME FEE FOR JOINING THE MLS IS $600. THIS IS IN ADDITION TO THE DUES ABOVE.

MLS ONLY PARTICIPANT:

$200 FOR JAN-DEC. IF JOINING IN ANY MONTH OTHER THAN JANUARY, PLEASE MULTIPLY $16.67 BY HOW MANY MONTHS REMAIN IN THE YEAR. YOU MUST INLCUDE FROM THE DATE YOU BECAME ACTIVE WITH YOUR CURRENT BROKER, NOT THE DATE YOU ARE FILING YOUR APPLICATION. PLEASE INCLUDE AN APPLICATION FEE OF $100.

**FOR BROKERS ONLY: ALL AGENTS IN YOUR OFFICE MUST JOIN. YOUR ONE-TIME FEE FOR JOINING THE MLS IS $800. THIS IS IN ADDITION TO THE DUES ABOVE.

ADDITIONAL MONTHLY MLS ACCESS FEES:

There are monthly fees as well for MLS Access that are billed to the broker at the end of each month:

If you have a Supra eKey and are a member the charge is $31

If you have a Co-Op key (ekey or Active) and are a member the charge is $16

If you have a Supra Active Key and are a member the charge is $33

If you are a member without a Supra key the charge is $33

If you are a MLS Only Participant the charge is $35, unless you have a Co-Op Key

If you have a Co-op key and are MLS Only the charge is $20

1041 Village Park Dr. Ste. 103, Greensboro, Ga. 30642

Phone: 706-453-0823/888-453-0823 Fax: 706-453-0923

Email:

LCBOR Membership Application – Last Revised 11-2-15 by NR