SIRA Membership Application Form

SIRA Realtor Membership Application

To apply for membership within the Southern Indiana REALTORS Association please complete all questions provided below.
Are you a REALTOR® member with another association?*

NoYes
Application Type*

New MemberSecondary (Primary membership with another association)MLS Only Membership
Applicant Contact Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number
Cellular Number*
Work Number
E-mail*
example@example.com
Website
Applicant Licensing Information
Indiana Realtor License #*
Secondary / MLS Only Member Information
Are you licensed in any additional states?

YesNo
Please provide State / License #
What is your NRDS#?
List Primary Association
Brokerage Name*
Brokerage Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Brokerage Phone*
Please enter a valid phone number.
Brokerage Website
Designated Realtor / Managing Broker Information
Designated Realtor / Managing Broker Name*

First NameLast Name
Applicant Preferences
Key Access for Boxes

App on Smartphone
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.

By signing below I consent that the REALTOR® Associations (local, state, national) and their subsidiaries, if any 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.

I acknowledge that if accepted as a member and subsequently resign from the Board or otherwise cause membership to terminate with a an ethics complaint pending, The Board of Directors may condition renewal of membership upon my certification that I will submit to the pending ethics proceeding and will abide by the decision of the hearing panel If I resign or otherwise cause membership to terminate, the duty to submit to arbitration continues in effect even after membership lapsed or is terminated, provided the dispute arose while I was a REALTOR.

I agree to abide by the Code of Ethics of the National Association of REALTORS, including the duty to arbitrate disputes in accordance with the Code of Ethics and Arbitration Manual, all relevant Bylaws, Rules and Regulations, and agree to complete satisfactorily reasonable and nondiscriminatory written examination covering items such as the Code of Ethics, Bylaws, Rules and Regulations, and duty to arbitrate, as from time to time amended.

I hereby authorize SIRA®, or its designated appointee, to conduct a criminal background check of me. Should any additional information be necessary to conduct this background search, I agree to provide that upon written request of SIRA®.

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Please Note: If you are a secondary or MLS only a letter of good standing from your primary association will be requested.
Applicant Signature*

Clear
Signature Date

MonthDayYear
Date
Should be Empty:

SIRA Realtor Membership Application

Applicant Contact Details

Applicant Licensing Information

Secondary / MLS Only Member Information

Designated Realtor / Managing Broker Information

Applicant Preferences