REALTOR® Office and Designated REALTOR® Certification Form

This form is for current members who are transferring to open their own office.

Fields marked with an * are required.

Firm Name *

Name of Designated REALTOR® *

Phone *

Designated REALTOR®

Email *

Designated REALTOR®

License Number *

Designated REALTOR®

Address Line 1 *

Firm

Address Line 2

Firm

City *

Firm

Postal Code *

Firm

Phone *

Firm

Email *

Firm

Dues Policy Acknowledgement

This Mid-Valley Association of REALTORS® dues policy provides that: the dues for each Designated REALTOR® shall be a base amount plus an amount multiplied by the number of real estate salespersons and licensed or certified appraisers who: (1) are employed by or affiliated with as independent contractors or who are otherwise directly or indirectly licensed or certified with such REALTOR® member; (2) are not REALTOR® or Institute Affiliate members of Mid-Valley Association of REALTORS®, and the Designated REALTOR® notifies the Mid-Valley Association of REALTORS® in writing of the Mid-Valley Association of REALTORS® which dues have been paid. The dues liability of the Designated REALTOR® for each non-member is $599.00* Therefore, please list all real estate licensees and licensed or certified appraisers in the firm and the primary Board or Association affiliation, if any. If no membership at any Mid-Valley Association of REALTORS® in the state, please note this next to that member. This list shall be used by the Mid-Valley Association of REALTORS® for dues calculation. (Computer printouts with the same information are acceptable). Do you acknowledge these terms?

List of real estate salespersons and licensed or certified appraisers within firm.

You may upload a list or file if you already have one.

File must be a .PDF .Doc or .Docx

20MB max

List of real estate salespersons and licensed or certified appraisers within firm.

If you do not have a file, you may list your members here.

Active Licensees:

Please list: First Name, Last Name, License Number, if they are a non member or if they hold membership at another association.
*non-members are office staff and assistants that don't fully practice but have a active license.

The above represents the status of all licensees in this office as of: *

Please list today's date:

I agree that all information provided in this form is true and accurate to the best of my knowledge. *

Additional Comments

Please verify that you have checked the “I'm not a robot” checkbox.