Application for Membership in the

Application for Membership in the

Greater Allegheny-Kiski Area Board of REALTORS^®

^{P
O BOX 235, NATRONA HEIGHTS, PA 15065-0235}

^{Telephone
724-226-8637 ~
Fax 724-226-8647 ~}^Email^executive^{@gakarealtors.com}

SECTION I

(Applicants for primary, secondary, or Designated REALTOR^® membership, are required to complete section I and II. Applicants for REALTOR® membership who are principals, partners, corporate officers or branch office managers must also complete Addendum I-A.

Type in the following information, print out completed form, sign, enclose check and mail to:

Greater Allegheny-Kiski Area Board of REALTORS^®^{P O BOX 235, NATRONA HEIGHTS, PA 15065-0235}

Applicant's name

Home Address: City

State: PA Zip Home Phone: EMAIL

Business Address:

City State: PA Zip EMAIL

Business Phone: FAX

I hereby apply for REALTOR^® (primary, secondary, or Designated) membership in the above named board/association, and enclose my check in the amount of $ , which I understand will be returned to me in the event I am not accepted to membership. In the event my application is approved, I agree as a condition to membership to complete the indoctrination course of the above named board/association, if any, and otherwise on my own initiative to thoroughly familiarize myself with the Code of Ethics of the NATIONAL ASSOCIATION OF REALTORS^®, including the duty to arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the board and the constitution, bylaws, and rules and regulations of the above named board, the state association and the National Association. I further agree that my act of paying dues shall evidence my initial and continuing commitment to abide by the aforementioned Code of Ethics, constitution, bylaws, rules and regulations, and duty to arbitrate, all as from time to time amended. Finally, I consent and authorize the board, through its membership committee or otherwise, to invite and receive information and comment about me from any member or other person, and I agree that any information and comment furnished to the board by any member or other person in response to any such invitation shall be conclusively deemed to be privileged and not form the basis of any action by me for slander, libel, or defamation of character.

NOTE: Applicant acknowledges that the board/association will maintain a membership file of information which may be shared with other boards/associations where applicant subsequently seeks membership. This file shall include: previous applications for membership; all final findings of Code of Ethics violations and violations of other membership duties within the past three (3) years; pending complaints alleging violations of the Code of Ethics or alleging violations of other membership duties; incomplete or pending disciplinary measures; pending arbitration requests; and information related to unpaid arbitration awards or unpaid financial obligations to the board/association.

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®.

NOTE: Dues payments to the board/association are not tax deductible as charitable contributions. Portions of such payments may be tax deductible as ordinary and necessary business expenses.

I hereby submit the following information for your consideration:

Name as shown on license

Name to appear on roster

License number

License type: Broker Salesperson

Other - - please specify

Name of firm

Office address City

State: PA Zip EMAIL

Business Phone: FAX

Position with firm: Principal Partner Corporate Officer Branch Office Manager

Employee Independent Contractor Other

If "other", please explain:

I agree that, if accepted for membership in the board, I will pay the fees and dues as from time to time established.

Date:

Signature:___________________________________________________________

(Applicant's usual form of signature)

SECTION II

Are you a member of an institute, society or council affiliated with the NATIONAL ASSOCIATION OF REALTORS^®?
Yes No

If yes, please indicate name of affiliated institute, society, or council:

List below any professional designations you hold:

Note: An applicant for Institute Affiliate Membership shall supply to the Membership committee evidence that applicant holds a professional designation awarded by a qualified institute, society or council affiliated with the NATIONAL ASSOCIATION OF REALTORS^®that addresses a specialty area other than residential brokerage or who otherwise holds a class of membership in such institute, society or council that confers the right to vote or hold office and shall agree, if elected to membership, to abide by the constitution, bylaws and rules and regulations of the local board, the state association, and the National Association.

Are you currently a member of another board or association which is affiliated with the NATIONAL ASSOCIATION OF REALTORS^® or have you held membership in another board or association within the past three (3) years? Yes No

If "yes," list each board and association where membership was held, type of membership held, and approximate dates of membership.

Have you been a user or subscriber in a multiple listing service which is owned and operated by a board or association affiliated with the NATIONAL ASSOCIATION OF REALTORS^® within the past three (3) years?

Yes No

If "yes," list the name of each MLS and the approximate dates of participation

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, may be grounds for revocation of my membership, if granted.

Signature_________________________________________________________

Date ______________________