Indiana Commercial Board of REALTORS

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Created in 1994, the Indiana Commercial Board of REALTORS (ICBR) coordinates education, information, networking and public policy for the benefit of its members. ICBR is unique as a statewide Board of REALTORS and in having membership made up of real estate practitioners dedicated to serving the needs of commercial clients in aspects of brokerage, leasing, appraising, property management and development. Section I To the Indiana Commercial Board of REALTORS, I hereby apply for membership and enclose my payment in the amount of $, which I understand will be returned to me in the event I am not accepted to membership. In the event of my election, I agree to abide by the Code of Ethics of the National Association of REALTORS, which includes the duty to arbitrate, and the Constitution, Bylaws and Rules and Regulations of the above named Board, the State Association and the National Association, and if required, I further agree to satisfactorily complete a reasonable and non-discriminatory written examination on such Code, Constitutions, Bylaws and Rules and Regulations. I understand membership brings certain privileges and obligations that require compliance. Membership is final only upon approval by the Board of Directors and may be revoked should completion of requirements, such as orientation, not be completed within timeframe established in the association s bylaws. I understand that I will be required to complete periodic Code of Ethics training as specified in the association s bylaws as a continued condition of membership. NOTE: Applicant acknowledges that if accepted as a member and he/she subsequently resigns from the Board or otherwise causes membership to terminate with an ethics complaint pending, the Board of Directors may condition renewal of membership upon applicant s certification that he/she will submit to the pending ethics proceeding and will abide by the decision of the hearing panel. If applicant resigns or otherwise causes membership to terminate, the duty to submit to arbitration continues in effect even after membership lapses or is terminated, provided the dispute arose while applicant was a REALTOR. Name: Real Estate License Number: Date of Birth Appraisal License Number: (if applicable) If you are now or have ever been a REALTOR, indicate your NAR membership (NRDS) number: Last date (year) of completion of NAR s Code of Ethics training requirement: I am: An applicant for Designated REALTOR (DR) seeking primary or secondary status who is a principal, partner, corporate officer or branch office manager. An applicant for REALTOR (R) seeking primary or secondary status where the Principal Broker is a member of a Board of REALTORS. Principal Broker Name: An applicant for REALTOR (R) seeking primary status where the Principal Broker is not a member of a Board of REALTORS. A principal broker must join to make non-principals eligible. I would like to make ICBR my: Primary Board (Pay State & National dues through Commercial Board) Secondary Board (Pay State & National through another REALTOR Board) If Secondary, list name of your Primary Board: List name of Principal Broker s Primary Board: Continued

Office Name: Office Address: City/State/Zip: County: Phone: Fax: Email: Home Address: City/State/Zip: Phone: Fax: Email: Cell Phone: Preferred Mailing: [ ] Home [ ] Office Preferred Phone: [ ] Home [ ] Office Preferred Email: [ ] Home [ ] Office Are you presently a member of any other Association of REALTORS? [ ] Yes [ ] No If yes, name of Association and type of membership held: Have you previously held membership in any other Association of REALTORS? [ ] Yes [ ] No If yes, name of Association and type of membership held: Have you been found in violation of the Code of Ethics or other membership duties in any Association of REALTORS in the past three (3) years or are there any such complaints pending? [ ] Yes [ ] No If yes, provide details as an attachment. Are you a principal, partner, corporate officer or branch office manager? [ ] Yes [ ] No If yes, complete Section II and III this application. I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established. NOTE: Payments to the Indiana Commercial Board of REALTORS are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. No refunds. By signing below I consent that the REALTOR Associations (local, state, national) and their subsidiaries, if any (e.g., MLS, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Association(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership. Also, applicant consents that the Board, through its Membership Committee or otherwise, may invite and receive information and comment about applicant from any Member or other persons, and that applicant agrees that any information and comment furnished to the Board by any person in response to the invitation shall be conclusively deemed to be privileged and not form the basis of any action for slander, libel, or defamation of character. The applicant shall, with the form of application, have access to a copy of the Bylaws, Constitution, Rules and Regulations, and Code of Ethics. Signature: Date: Continued

Section II For Principal Brokers/Branch Managers only. Company Information Corporation LLC (Limited Liability Company) Partnership Sole Proprietor Other - Please Specify. Your Position Branch Manager Corporate Officer Majority Shareholder Partner Principal Names of other Partners/Officers/of your firm: Have you ever been refused membership in any other Association of REALTORS? [ ] Yes [ ] No If yes, state the basis for each such refusal and detail the circumstances related thereto: Is the Office Address, as stated, your principal place of business? [ ] Yes [ ] No If not, or if you have any branch offices, please indicate and give address: Do you hold, or have you ever held, a real estate license in any other state? [ ] Yes [ ] No If so, where: Have you or your firm been found in violation of state real estate licensing regulations within the last three years? [ ] Yes [ ] No If yes, provide details: Have you or you firm been convicted, adjudged, or otherwise recorded as guilty by a final judgment of any court of competent jurisdiction of a felony or other crime? [ ] Yes [ ] No If yes, provide details: I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time to time established. NOTE: Payments to the Indiana Commercial Board of REALTORS are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. No refunds. By signing below I consent that the REALTOR Associations (local, state, national) and their subsidiaries, if any (e.g., MLS, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Association(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership. An applicant for REALTOR Membership who is a sole proprietor, partner, corporate officer, or branch office manager of a real estate firm shall supply evidence satisfactory to the Membership Committee that he is actively engaged in the real estate profession, and maintains a current, valid real estate broker s or salesperson s license or is licensed or certified by an appropriate state regulatory agency to engage in the appraisal of real property, has a place of business within the state or a state contiguous thereto (unless a secondary member), has no record of bankruptcy, has no record of official sanctions involving unprofessional conduct within 3 years, agrees to complete a course of instruction covering the Bylaws and Rules and Regulations of the Board, the Bylaws of the State Association, and the Constitution and Bylaws and Code of Ethics of the NATIONAL ASSOCIATION OF REALTORS, and shall pass such reasonable and nondiscriminatory written examination thereon as may be required by the Committee, and shall agree that if elected to membership, he will abide by such Constitution, Bylaws, Rules and Regulations, and Code of Ethics. Signature: Continued Date:

Section III For Principal Brokers/Branch Managers only. ICBR bylaws require all commercial brokers within a firm be REALTOR members of a Board of REALTORS if any other commercial broker within your firm is a member. Further, if the Designated REALTOR within your firm holds Primary REALTOR membership status with ICBR, all commercial brokers within your firm must also join ICBR. Please list all licensed brokers and salespeople in your office that are actively involved in the commercial real estate profession. Active Commercial Agents:

Payment Authorization Form Contact Information Name: Company: Address: Phone: Fax: Receipt Requested Email: Payment Information Payment may be accepted by check or credit. Check Payable to the Indiana Commercial Board of REALTORS Credit Credit Card Information Visa MasterCard American Express AUTHORIZED AMOUNT $ Cardholder Name: As it appears on card. Number: Expiration Date: CVC Billing Address: Reason for Payment Annual Conference ICREX Member Dues Other (Please specify.) Notes Internal Use Only ACH Settlement #: EC Control #: Order #: