NORTHSHORE AREA BOARD OF REALTORS
®
5001 Hwy. 190 East Service
Rd.., Unit A-4, Covington, LA 70433
WWW.NABORS.ORG 985-674-4233 OFFICE@nabors.org
MEMBERSHIP STATUS CHANGE FORM
IF THERE ARE ANY CHANGES TO YOUR MEMBERSHIP STATUS, PLEASE RETURN THIS FORM OR
SIMPLY E-M AIL UPDATES (NOTE SUBJECT LINE AS: STATUS CHANGE) TO OFFICE@nabors.org
Today's Date: / / PLEASE PRINT
AGENT NAME Phone:
Current Email : NRDS #:
**************************************************************************************************
Change #1: BROKER RETURNING LICENSE TO LREC: CHECK ONE
Agent going INACTIVE Agent Changing Brokers Agent Retired/Resigned/Deceased
Change #2: AGENT PROFILE INFORMATION CHANGED:
Agent Name Change FROM: TO
Change Home Address FROM:
TO:
Current Cell Phone Number
Current E-MAIL Address
Change #3: TRANSFERRING COMPANY / BROKER:
New Broker's Name: New Company:
New Company Address: Office Phone:
Former Broker’s Name: Former Company:
Change #4: BOARD CHANGES
PRIMARY Board change:
De
signate NABOR as my Primary Board. Former Primary Board
Terminate my membership in NABOR – My new Primary Board is
SECONDARY Board change:
De
signate NABOR as my Secondary Board Terminate my secondary membership in NABOR
I ATTEST THE ABOVE INFORMATION TO BE TRUE: SIGNATURE
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