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KERSHAW COUNTY BOARD OF REALTORS®

MEMBERSHIP APPLICATION

I hereby apply for ______REALTOR______Membership to

(Realtor® or Secondary Realtor®)

The Kershaw County Board of Realtors, the South Carolina Association of Realtors®, and the National Association of Realtors.

I am enclosing my check for fees in the amount of $ which is to be returned to me in the event of non-election. In the event of my election, I agree to arbitrate all contractual disputes with fellow REALTORS® and to abide by the Code of Ethics of the National Association of Realtors®, and the Constitution, By-Laws, and Rules and Regulations of the above named Board/Association, the State Association and the National Association. I consent that the Board/Association, through its Membership Committee or otherwise, may invite and receive information and comment about me from any Member or other person, and I further agree that any information and comment furnished to the Board/Association by any person in response to the invitation shall be conclusively deemed to be privileged and not from the basis of any action by me for slander, libel, or defamation of character. I hereby submit the following information for your consideration:

Name as shown on Real Estate License ٱ Ms. ڤ Mrs. ڤ Mr. ______

(Please Print)

License No. ______ڤ Broker ڤ Salesman Home Phone ______

Email Address______(Enter in database) ___yes ___no Cell Phone______

Please check one

Office Address ______City______State______Zip______

Mailing Address______City______State______Zip______

(If different)

Home Street Address ______-City______State______Zip______(State Association files will be setup with all addresses. Immediately notify your Local Board/Association of any changes.)

Name of Firm ______Office Phone # ______

Office Fax #______Office Email Address:______

My title or position with the firm ______

Partners or Office (if a corporation) ______

Are you actively engaged in the real estate business? ڤ Yes ڤ No

Do you hold yourself out to the general public as being actively engaged in the real estate business? ڤ Yes ڤ No

You are authorized to contact the following references:

______

Name Address Phone

______

Name Address Phone

Local: Application fee: $30.00 and Local dues: $180.00; State: State Dues: $130.00; State Legal Assessment fee: $25.00 (New Members Only) and Issues Mobilization Assessment: $10.00; National: National Dues: $120.00 and National Campaign Advertising Fund $35.00.

Submit application with payment to: KCBR – P. O. Box 484 – Camden, SC 29021 - Phone: (803)425-1978 mobile (803)318-0485

It is understood that this application and the fees stated include Membership in the South Carolina Association of Realtors® and the National Association of Realtors®.

Dated ______, 20______Signed ______

This application submitted through ______

Signature (Designated Realtor®Member (BIC)

PERSONAL DATA

Applicant: ______Date of Birth ______

(Nickname) ______

First entered the real estate business ______, 20______, at ______

Have you been engaged continuously in the business since then? ڤ Yes ڤ No

If not, during what years were you in the business? ______

How many years have you been active as a: Salesman ______Broker ______

List membership in professional societies, fraternal orders, service organizations, Boards/Association of Realtors®, political office, etc.

______
______
______

First licensed in SC ______, 20______, and continuously licensed since ______

Established in present location: ______, 20______. Last previous location ______

Resident here since ______, 20______. Previous residence ______

Are you, or have you been a Member of any Local Board/Association? ڤYes ڤ No If yes, which one(s) ______

Have you participated in a Multiple Listing Service? ڤ Yes ڤ No If yes, where? ______

What amount of your business time do you devote to real estate? ______

Which branches of real estate do you specialize in? (check all that apply) ____% Single-family Homes Sales ____% New Home Sales

____% Commercial ____% Appraising ____% Property Management ____% Other ______

Are you now employed in any other business or profession? ڤ Yes ڤ No

Position ______Location______Date______

Will you serve on a State or Local committees (if appointed)? ڤ Yes ڤ No Committee preference ______

Have you or your firm ever been disciplined by a Local Board/Association? ڤ Yes ڤ No By a licensing agency? ڤ Yes ڤ No

Is so, give details*:______
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*attach separate sheet(s) as needed.