Preferred Mailing Address: __ Home __ Office Preferred Phone: __ Home __ Office __Cell
Previous board/association membership? __ Yes __ No
If yes, please list your NRDS #:________________________________
Has your real estate license, in this or any other state, been suspended or revoked? __ Yes __ No
(If yes, provide details as an attachment.)
Have you been found in violation of the Code of Ethics or other membership duties in any Association of
REALTORS® in the past three years or are there any such complaints pending? __ Yes __ No
(If yes, provide details as an attachment.)
Signature
I agree to the following membership conditions:
I consent and authorize the Board, through its Membership Committee or otherwise, to invite and receive
information and comments about me from any Member or other person, and agree that any information and
comments, furnished to the Board by any Member or other person, in response to any invitation, shall be
conclusively deemed to be privileged and not form the basis of any action against the Board, by me, for slander,
libel or defamation of character.
To arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the Association as
time to time amended.
To pay the fees and dues as established.
To discontinue the term “REALTOR®” in the event that my membership is terminated or suspended for any
cause. I hereby consent to receive fax and e-mail transmissions from Greater Bergen of REALTORS®, New Jersey
Association of REALTORS® and the National Association of REALTORS® to my fax and e-mail addresses as set
forth above.
____________________________________________________ _________________________________________________
Signature of Applicant Date
I certify that the above named applicant holds the license, as indicated, which is in my possession and on display
in my office at:
Office Street Address:
___________________________________________________________________________________________________
Office City/State Zip:
____________________________________________________________________________________________________
Firm Name: ________________________________________________________________
Phone:___________________________________
___________________________________________ ____________________________________
REALTOR® (Signature of Licensed, Employing Broker) Date
To Be Completed By the Licensed Employing Broker
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