REALTOR®
To the Greater Portland Board of REALTORS®, I hereby apply for REALTOR® Membership in the above named Board,and I authorize payment to the credit/debit card included herein in the amount of$175.00,for a one time non-refundable application fee* and $______ for my dues (see Page 2 for prorated amount).Upon my signature to this application, I agree to abide by the Code of Ethics of the National Association of REALTORS®, and the Constitution, Bylaws and Rules and Regulations of the above named Board, the State Association and the National Association.If required, I further agree to satisfactorily complete a reasonable and non-discriminatory written examination on such Code, Constitutions, Bylaws and Rules and Regulations. I consent that the Board, through its Membership Committee or otherwise, may invite and receive information and comment about me from any member or other person. I further agree that any information and/or comment furnished to the Board by any person in response to the invitation shall be conclusively deemed to be privileged and not form the basis of any action by me for slander, libel, or defamation of character.
*Application fee not applicable to members in good standing of another Maine REALTOR® board who is transferring to GPBR.
I hereby submit the following information for your consideration:
Name: ______Real Estate License No.______
(As it appears on your Maine license)
Date of Birth:______Please check one: [ ]Broker [ ]Associate Broker [ ]Sales Agent Licensee
Office Name: ______Office Phone:______
______
Office Street AddressCity State Zip
Home Address: ______Home Phone:______
Cell Phone:______E-Mail:______
(Required)
Do you consent to us including you in membership lists that we supply upon request to other members of this board?[ ]Yes [ ]No
Your position: [ ]Principal [ ]Partner[ ]Corporate Officer[ ]Trustee[ ]Employee[ ]Independent Contractor [ ]Other: ______
Names of Principles/Partners/Officers/Trustees of your firm:______
Do you hold yourself out to the general public as being actively engaged in the real estate business? [ ]Yes [ ]No
First entered the real estate business in the year______.Have you been engaged continuously in the business since then?[ ]Yes[ ]No
If not, during what years were you in the business?______
Are you a member of any other real estate Board affiliated with the National Association of REALTORS®? [ ]Yes [ ]No
If yes, name of Board and type of membership:______
______
Have you previously held membership in any other REALTOR® Board? [ ]Yes [ ]No If yes, name of Board and type of membership?______
______
______
Do you wish to be a PRIMARY Member in this Board? [ ]Yes [ ] No(Answer Yes if this is the only REALTOR® board you belong to.)
Revised 08/17
Have you ever been refused membership in any other real estate Board? [ ]Yes [ ]No If yes, state the basis for each such refusal and detail the circumstances related thereto:______
______
Is the Office Address, as stated, your principal place of business? [ ]Yes [ ]No If not, or if you have any branch offices, please indicate and give address:______
______
Do you hold, or have you ever held, a real estate license in any other state? [ ]Yes [ ]No If so, please specify:______
Has your real estate license in this state, or any other, ever been suspended or revoked? [ ]Yes [ ]No If yes, please specify dates and details:______
Are there now, or have there been any complaints, within the last five years, against you? [ ]Yes [ ]No If yes, please specify: ______
Have you ever been convicted of a felony? [ ]Yes [ ]No If yes, please specify:______
______
I hereby certify that the 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 fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established.
**NOTE: Payments to Greater Portland Board of REALTORS® are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense.
Date Applicant Signature
2018DUES PRORATION (based on DATE OF LICENSE* and inclusive of $25 optional RPAC donation):
☐I do not wish to make an RPAC donation at this time. (Subtract $25 from the amounts below.)
JAN - $522.00 FEB - $483.50MAR - $445.00 APR - $406.50 MAY - $368.00 JUN - $329.50
JUL - $291.00 AUG - $252.50 SEPT - $214.00 OCT -$175.50 NOV - $137.00 DEC - $98.50
*If membership was not held in the past 12 months.
PAYMENT INFOName on Credit/Debit Card:______
Type of Card: [ ]Visa [ ]MC [ ]AMEX [ ]DiscoverCard Number:______
Expiration Date:_____/_____ CVV: _____Billing Address:______
(Month) (Year) (If different from home address)
Revised 12/17
1