Mid-state association of realtors, inc. The Association with the Personal Connection 73 East Main St. Plainville, CT 06062

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1 MEMBERSHIP APPLICATION - REALTOR AGENT GENERAL INFORMATION Name (as it appears n yur license): Name (as yu wish it t appear n rster): Firm Name: Firm Address: (Street) (City) (State) (Zip Cde) Firm Phne Number ext. Firm Fax number: Date f Birth: Hme Address: (Street) (City) (State) (Zip Cde) Hme Phne Number: Hme Fax Number (if ne): Mbile Phne Number Service Prvider: Opt In t Text Message Services: ( Yes r N) Preferred Phne Mbile Hme Primary mailing address? Firm Hme Address: License #: Expiratin Date: Page 1

2 MEMBERSHIP TYPE New * Secndary Membership *Assciatin Transfer *SECONDARY MEMBERSHIP AND ASSOCIATION TRANSFER MEMBERS WILL REQUIRE US TO OBTAIN A LETTER OF GOOD STANDING FROM THE PREVIOUS ASSOCIATION. Currently Member with anther Assciatin in CT Yes N Currently Member f anther State Assciatin Yes N CURRENT REALTOR Assciatins membership and NRDS member number: PREVIOUS REALTOR Assciatins membership and NRDS member number: Prfessinal Designatins: GRI - Graduate REALTOR Institute SRES - Real Estate Specialist CRS - Certified Residential Specialist Other(s) please specify: Primary Specialty: Residential Brkerage Prperty Management Cmmercial/Industrial Brkerage Appraising Farm and Land Brkerage Mrtgage Financing Building and Develpment Other(s) please specify: Persns ther than principals, partners, crprate fficers r branch ffice managers f real estate firms must remain affiliated with a Designated REALTOR t be eligible fr REALTOR membership. Name f Designated REALTOR brker: Yes N Have yu been disciplined by any REALTOR Assciatins? (Please attach cpies f the discipline.) Yes N Have yu ever been disciplined by the DCP? Please prvide all relevant details and dates (r attach cpies f discipline.) Page 2

3 CONDITIONS OF MEMBERSHIP SIGNATURE I hereby apply fr membership in the Mid-State Assciatin f REALTORS, enclsing my payment fr dues and nn-refundable applicatin fee ($125). (Waived if previusly belnged t anther assciatin r a returning member f the Mid-State Assciatin.) In the event my applicatin is apprved, As a New REALTOR, I agree as a cnditin f membership t cmplete the rientatin curse f the Mid-State Assciatin f REALTORS within six (6) mnths and familiarize myself with the Cde f Ethics f the NATIONAL ASSOCIATION OF REALTORS, including the duty t arbitrate business disputes in accrdance with the Cde f Ethics and Arbitratin Manual f the Assciatin and the, By Laws and Rules & Regulatins f the abve named Assciatin, the state Assciatin and the Natinal Assciatin f REALTORS. I understand that I will be required t cmplete peridic Cde f Ethics training as specified in the assciatin s bylaws as a cntinued cnditin f membership. (Transfer Members and Returning Members are nt required t underg Orientatin) I further agree that my act f paying dues shall evidence my initial and cntinuing cmmitment t abide by the afrementined Cde f Ethics, Bylaws, Rules and Regulatins, and the duty t arbitrate, all as frm time t time amended. I authrize the assciatin thrugh it directrs, cmmittee and/r staff members t make an investigatin f my character as may deem necessary. I acknwledge, cnsent and fully understand that the infrmatin btained as the result f the investigatin will be fr the Assciatins use nly. Further, I shall nt use any infrmatin btained r furnished in cnnectin with such investigatin as the basis f any legal actin fr slander, libel r defamatin f character. I als acknwledge that if accepted as a member, and I subsequently resign frm the Assciatin r therwise cause membership t terminate with an ethics cmplaint pending, the Bard f Directrs may cnditin renewal membership upn my certificatin that I will submit t the pending ethics prcedure and will abide by the decisin f the hearing panel. If I resign r therwise cause membership t terminate, the duty t submit t arbitratin cntinues in effect even after my membership lapses r is terminated, prvided the dispute arse while I was a REALTOR. APPLICANT I certify that I have read and agree t the terms and cnditins f this applicatin and that all infrmatin given in this applicatin is true and crrect. Signature f Applicant / / Date f Signature Designated REALTOR (Brker) I certify that I have read and agree t the terms and cnditins f this applicatin and that all infrmatin given in this applicatin is true and crrect. Brker f Recrd Signature / / Date f Signature Page 3

4 Mnth Jined Mid-State Assciatin Dues CTR Dues 2018 REALTOR DUES SCHEDULE DUES ARE PRORATED ON A MONTHLY BASIS NAR Dues Vluntary PAF TOTAL NEW MEMBERS New REALTOR Admin Fee TOTAL DUE NEW REALTORS January $ $ $ $15.00 $ $ $ February $ $ $ $15.00 $ $ $ March $ $ $ $15.00 $ $ $ April $ $ $ $15.00 $ $ $ May $ $ $ $15.00 $ $ $ June $ $ $ $15.00 $ $ $ July $92.50 $87.50 $95.00 $15.00 $ $ $ August $92.50 $74.58 $85.00 $15.00 $ $ $ September $92.50 $61.67 $75.00 $15.00 $ $ $ Octber $46.25 $48.75 $65.00 $15.00 $ $ $ Nvember $46.25 $35.83 $55.00 $15.00 $ $ $ December $46.25 $22.92 $45.00 $15.00 $ $ $ Mid-State prtin f yur dues is 100% tax deductible. The amunt f CTR Dues which are dedicated t lbbying and therefre nn-deductible is 40% f $165 ($66). The nndeductible prtin fr NAR is 43% f $120 ($52). The NAR Image Assessment fee is deductible. The assessment fee fr bth NAR and CTR is nt subject t pr-ratin. Affiliates d nt pay NAR dues r assessment. CTR Dues are Vluntary fr Affiliate Members. The amunt f CTR s Affiliate dues which is nn-deductible is 36% f $155 ($56). Schlarship Cntributins are tax deductible. Please check with yur financial advisr. Plitical Actin Fund (PAF) Cntributins are nt tax deductible. Vluntary cntributins t the Plitical Actin Fund are used fr state and federal issues purpses, nt candidates and split 70% t the CT Realtrs Issues Fund and 30% t the NAR Plitical Actin Fund. Page 4

5 GENERAL TERMS AND CONDITIONS OF MEMBERSHIP (Please keep this page fr yur recrds) 1. Bylaws, plicies and rules. I agree t abide by the bylaws, plicies and rules f the Assciatin, the bylaws, plicies and rules f the Cnnecticut Assciatin f REALTORS, and the cnstitutin, bylaws, plicies and rules f the Natinal Assciatin f REALTORS, all as they apply t the categry f membership I am applying fr and as may frm time t time be amended. 2. Use f the term REALTOR. I understand that the prfessinal designatin REALTOR is a federally registered trademarks f the Natinal Assciatin f REALTORS ( NAR ) and use f this designatin is subject t N.A.R. rules and regulatins. I agree that I cannt use this prfessinal designatin until this applicatin is apprved, all my membership requirements are cmpleted, and I am ntified f membership apprval f this designatin. I further agree that shuld I cease t be a REALTOR, I will discntinue use f the term REALTOR in all certificates, signs, seals r any ther medium. 3. Orientatin. I understand that the Assciatin requires rientatin as mandated by N.A.R. t fully cmply with the REALTOR requirements fr membership. I must attend rientatin upn written ntificatin by the Assciatin within 6 mnths f submissin f applicatin. Additinal Applicatin fees can be assessed if I d nt cmplete rientatin within 6 mnths. 4. N refund. I understand that my Bard/Assciatin membership dues are nn refundable. In the event I fail t maintain eligibility fr membership fr any reasn, I understand I will nt be entitled t a refund f my dues and fees. 5. Authrizatin t release and use infrmatin; waiver. I authrize the Assciatin r its representatives t verify any infrmatin prvided by me in this applicatin by any methd including cntacting the Cnnecticut Department f Cnsumer Prtectin, my current r past respnsible brker r designed REALTOR, r any Assciatin where I held, r cntinue t hld, any type f membership t release all my membership r disciplinary recrds t this Assciatin, including infrmatin regarding (I) all final findings f Cde f Ethics vilatins r ther membership duties within the past three (3) years; (ii) pending ethics cmplaints (r hearings); (iii) unsatisfied discipline pending; (iv) pending arbitratin requests (r hearings); and (v) unpaid arbitratin awards r unpaid financial bligatins. I understand that any infrmatin gathered under this authrizatin may be used in evaluating my applicatin fr membership and future disciplinary sanctins. I waive any legal claim r cause f actin against the Assciatin, its agents, emplyees r members including, but nt limited t, slander, libel r defamatin f character, that may arise frm any actin taken t verify, evaluate r prcess this applicatin r ther use f the infrmatin as authrized and released hereunder. 6. Arbitratin Agreement; REALTOR : A cnditin f Membership in the Assciatin as A REALTOR is that yu agree t binding arbitratin f disputes. As a REALTOR (including Designated REALTOR ), yu agree fr yurself and the crpratin r firm fr which yu act as a partner, fficer, principle r branch ffice manager t binding arbitratin f disputes with (i) ther REALTORS members f this Assciatin; (ii) with any member f the Califrnia r Natinal Assciatin f REALTORS ; and (iii) any client prvided the client agrees t binding arbitratin at the Assciatin. 7. All assciatin cmmunicatins are sent via unless members request t receive hard cpies. Page 5

6 DISCLOSURE & ACKNOWLEDGMENT The Mid-State Assciatin f REALTORS cntinuusly strives t be in cmpliance with current FTC CAN- SPAM regulatin. In ding s, Mid-State requires that this Disclsure & Acknwledgement Ntice be cmpleted in full. Please read this Disclsure in its entirety and prvide infrmatin as requested belw. Why be added t Mid-State Distributin? Receive Mid-State s membership cmmunicatins. Be reminded f Mid-State Events: Membership Meetings, Scial Events, Educatinal Opprtunities Receive up-t-date Legislative Alerts and Calls t Actin n imprtant Lcal, State and Natinal Levels Be infrmed f the latest news and valuable tls frm the industry I wish t submit the fllwing address t Mid-State as the address Mid-State shuld use t send its cmmunicatins t: I understand that my address will als be submitted t the CT Assciatin f REALTORS (CAR) and the Natinal Assciatin f REALTORS (NAR). I als realize that Mid-State affiliate members may have access t my . Yu may add my address t the Mid-State Bradcast distributin lists. The Mid-State Bradcast service will send ut s n behalf f ur members fr a small fee. Yu can remve yurself at any time just by sending an t MidState@MidStateRealtrs.cm with REMOVE in the subject line. We try t nly send ne bradcast a day and will nly send t Members f the Mid- State Assciatin. By signing this Disclsure & Acknwledgment Ntice, yu are authrizing the Mid-State Assciatin t add the address yu have prvided t ur distributin lists. Signature Date Remember, yu may request t change yur address with us as yu need t. Simply send us an and prvide us with a new address. yur request t MidState@MidStateRealtrs.cm. Page 6

7 One Time Credit Card Payment Authrizatin Frm Sign and cmplete this frm t authrize Mid-State Assciatin f REALTORS t make a ne time debit t yur credit card listed belw. By signing this frm yu give Mid-State Assciatin f REALTORS permissin t debit yur accunt fr the amunt indicated n r after the indicated date. This is permissin fr a single transactin nly, and des nt prvide authrizatin fr any additinal unrelated debits r credits t yur accunt. Please cmplete the infrmatin belw: I authrize Mid-State Assciatin f REALTORS t charge my credit card listed belw. By signing this frm yu give us permissin t debit yur accunt fr the amunt f n r after. This payment is fr (amunt) (date). (descriptin f gds/services) Billing Address Phne# City, State, Zip Accunt Type: Visa MasterCard Discver Cardhlder Name Accunt Number Expiratin Date CVV2 (3 digit number n back f Visa/MC, 4 digits n frnt f AMEX) SIGNATURE DATE I authrize the abve named business t charge the credit card indicated in this authrizatin frm accrding t the terms utlined abve. This payment authrizatin is fr the gds/services described abve, fr the amunt indicated abve nly, and is valid fr ne time use nly. I certify that I am an authrized user f this credit card and that I will nt dispute the payment with my credit card cmpany; s lng as the transactin crrespnds t the terms indicated in this frm. Page 7