First Name *

Last Name *

What type of membership do you currently hold? *

Primary REALTOR®

Secondary REALTOR®

Affiliate

RE License Number *

NRDS Number *

If you aren't sure, you can find your NRDS# at this link:

https://login.connect.realtor/#!/forgotmember

Email *

Why are you cancelling your membership? *

My license has expired and I won't be renewing.

I am putting my license with a referral office.

I am taking a break from Real Estate.

I do not find value in my membership.

Other

Requested Cancellation Date *

MM/DD/YYYY

Additional Comments

Disclaimer *

I understand by submitting this form, I am requesting to have my membership inactivated. I understand my membership can be reactivated. I am aware that inactivating my membership will make my NRDS number inactive as well.