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INSTRUCTIONS
1. Please download, fill, save, and electronically submit this application to assistant@slrealtors.com.
2. You can include payment information above, or we will email payment instructions to you after we receive your application.
3. When payment is confirmed and authorized, we will send a welcome email with important membership information.
To receive a Supra eKEY, you must complete this application in its entirety. Access to the Supra system is conditioned upon:
• The contents of this application
• Completion of the Board’s Code of Ethics course
• Proof of liability insurance
• A criminal background check
PLEASE SELECT YOUR BUSINESS TYPE
HOME INSPECTOR OTHER:
_________________________________________________________________________
SECTION 1 AFFILIATE INFORMATION
ARE YOU CURRENTLY A MEMBER OF ANOTHER REALTOR® ORGANIZATION? Yes No
(IF YES) PRIMARY REALTOR® ASSOCIATION NAME: _______________________________________________________________________________
NATIONAL REALTOR® (NRDS) #: _________________________________
SECTION 2 PERSONAL INFORMATION
FIRST NAME: _____________________________ MIDDLE NAME: _____________________ LAST NAME: __________________________________
PHONE: _______________________________________________ HOME CELL WORK OTHER
EMAIL ADDRESS: _____________________________________________________________ BIRTHDATE: __________________________________
HOME ADDRESS: __________________________________________________________________________________________________________
CITY: ____________________________________________________ STATE: _______________________ ZIP: ___________________________
LANGUAGES SPOKEN: English Spanish Mandarin Other: _____________________________________
GENDER: Male Female Non-binary VETERAN: Yes No
SECTION 3 COMPANY INFORMATION
COMPANY NAME: _________________________________________________________________________________________________________
COMPANY PHONE: ________________________________________ HOME CELL WORK OTHER
COMPANY ADDRESS: _______________________________________________________________________________________________________
CITY: _____________________________________________________ STATE: ______________________ ZIP: ___________________________
TITLE OR POSITION: _________________________________________________________________________________________________________
230 W. Towne Ridge Parkway, Ste. 100, Sandy, Utah 84070 ꟾ Phone: 801-542-8840 ꟾ Email: assistant@slrealtors.com ꟾ AFFILIATE KEY APPLICATION
Payment Type: VISA MC AMEX DISC
Card Number: _
Expires: _______ /_________
_________________________________________
CARD HOLDER SIGNATURE
AFFILIATE KEY APPLICATION
230 W. Towne Ridge Parkway, Ste. 100, Sandy, Utah 84070 ꟾ Phone: 801-542-8840 ꟾ Email: assistant@slrealtors.com ꟾ AFFILIATE KEY APPLICATION
1. Do you have knowledge of any complaint(s), investigation(s), or disciplinary action(s) currently ongoing or pending against you by
a regulatory or licensing body?
2. Have you ever been convicted of or plead “guilty” or “nolo contendere” to a felony, Class A or B misdemeanor, or comparable
criminal offense? A traffic violation can be prosecuted as a felony, Class A or B misdemeanor, or comparable criminal offense.
Disclosure is required if you have this kind of traffic violation on your record.
3. Have you ever resolved a felony, Class A or B misdemeanor, or comparable criminal offense (including traffic violations
prosecuted as such) through a plea in abeyance, diversion agreement, withheld judgment, or other method whereby a charge
was held in suspense during a period of time in which you were on probation or were obligated to comply with conditions
outlined by a court?
4. Are you aware of any investigation(s), indictment(s), or criminal charge(s) which are currently pending against you for any crime
in any jurisdiction?
5. Have you ever been subject to court martial or dishonorable discharge from any branch of the armed services?
6. Have you ever been required to register as a sex offender?
7. Have you ever had a judgment entered against you in a civil or bankruptcy court on the basis of fraud, misrepresentation, or
deceit?
8. Have you ever been found in contempt of court?
SS #: ___________________________________________________
I am a citizen of the United States with a social security number
I am a qualified alien under 8 U.S.C. 1641 and can provide an:
I-94 #: __________________________________________________
Alien #: _________________________________________________
SECTION 6 IDENTIFICATION
I have a valid Driver License License #: _______________________________________________________
State of Issue: ____________________________________________________
I have a valid State Identification Card Card #: __________________________________________________________
State of Issue: ____________________________________________________
SECTION 4 LEGAL ACTIONS
Check the appropriate box, as each statement applies to you.
YES NO
If you have answered "YES" to any of the questions above, you must provide a written explanation on a separate page and attach it to this application.
SECTION 5 CITIZENSHIP
*Attach a copy (front & back) of I-94 OR Alien # Card to this application
I certify under penalty of perjury that (check the appropriate box and enter the requested data):
I certify under penalty that I am legally present in the United States and that (check the appropriate box and enter the requested data):
SECTION 7 PROOF OF INSURANCE
By signing this document, I certify that I have a general liability insurance policy with a minimum of $1,000,000 of coverage and workmen’s
compensation insurance, in accordance with Utah law.
I have attached proof of my insurance policy to this application.
I agree to send the Board proof of insurance renewal and/or changes upon current policy expiration.
230 W. Towne Ridge Parkway, Ste. 100, Sandy, Utah 84070 ꟾ Phone: 801-542-8840 ꟾ Email: assistant@slrealtors.com ꟾ AFFILIATE KEY APPLICATION
MEMBERSHIP AGREEMENT
If my application is approved, I, the undersigned, agree to the following (please initial each box):
I hereby certify that I have read and understood this document, and that the information I have provided is true and accurate.
I certify that I am at least 18 years of age and have a minimum of a high school diploma or its equivalent.
I agree to notify the Board within ten (10) days in the possible future event that I am convicted of, or plead “guilty” or “nolo contendere” to
a felony, Class A or B misdemeanor, or comparable criminal offense (including traffic violations prosecuted as such).
I understand that the primary form of communication for the Salt Lake Board of Realtors® is email. I agree to check my email often so that I
don’t miss important Board communications, and will promptly notify the Board of any changes to my email address or other contact
information.
I agree to become familiar with the Code of Ethics, as well as the bylaws of the Salt Lake Board of Realtors®, which can be found on the
Board website. I will also familiarize myself with the rules and regulations of the Utah Association of Realtors®. The annual renewal of my
membership shall indicate my continued commitment to abide by the aforementioned standards as they are amended from time to time.
I further consent that the Board may request information and comment about me from any Board member or other persons. I accept that
any response (from any person) furnished to the Board in such an event shall be conclusively deemed to be privileged and not form the
basis of any action for slander, libel, or defamation of character.
I understand and agree that I will act in accordance to the Key Agreement I will sign upon receiving a Supra eKEY; namely that I will only use
said key to gain access to properties for which I have been contracted to provide services and have permission to enter. I agree to confirm
appointments before entering any property.
I agree to pay my annual renewal dues each June, in the amount specified to me by the Board. I understand that dues are subject to review
and possible change annually. I recognize that dues are non-refundable, and that once paid, they become the property of the Board. If I do
not renew, or my membership is terminated, I will immediately cease to represent myself as being affiliated with a Realtor® association.
I acknowledge that at least one member of my company must maintain an active Affiliate membership in order for me to avoid paying a
$200 re-entry fee, should I discontinue my membership and rejoin at a later date. If there are no active Affiliate members in my company
when I rejoin, I agree to pay the re-entry fee.
I consent that the Salt Lake, Utah, and National Association of Realtors® and their subsidiaries, may contact me using the information
provided on this form, or by other available means of communication. This consent extends to possible future changes in contact
information. I waive any limits placed on communication by certain state/federal laws in order to receive all membership communications.
DATE: ______________________________ APPLICANT SIGNATURE: __________________________________________
REQUIRED BACKGROUND CHECK
STEPS TO COMPLETE ONLINE BACKGROUND CHECK
1. Upon submission of this form, you will receive a welcome email from a Membership Department staff member. The email will contain a
link to Spectrum Security Group’s online background check.
2. Pay $15 to Spectrum Security Group and complete the online background check.
In connection with my application for access to the Supra key and lockbox system, I hereby agree to obtain and furnish for review the results of the
aforementioned background check. I understand that this report will provide details of the criminal background check, in order to ascertain any and
all information which may be relevant and pertinent to being approved for access to the Supra system. If the report shows that I have failed to
accurately disclose my criminal history or that I have a criminal record, I understand that access to the Supra system may be withheld or revoked, in
accordance with Board policies.
APPLICANT SIGNATURE: __________________________________________ DATE: ______________________________
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INSTRUCTIONS 1. Please download, fill, save, and electronically (Salt Lake Board of Realtors)

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Completed 31 January 2021

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