Certified Photographer Application

Certified Photographer Application
Company Name*
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Address
Phone Number*
Email*
example@example.com
Are You an Affiliate?*

YesNo
Are you Interested in becoming an Affiliate?*

YesNo
Membership Level*
How did you hear about us?*

MediaGold Coast SchoolsNew Licensee ProgramAgentBrokerBrokerageOther
Website or Social URL*
Locations Serviced by County (Select All That Apply)*

BrowardPalm BeachSt. LucieMartinMiami-DadeIndian River-Okeechobee
Types of Services Offered (Select All That Apply)*

Aerial/Drone PhotographyResidential Real Estate PhotographyCommercial Real Estate PhotographyVirtual ToursPhoto Enhancement3D/Matterport PhotographyEvent PhotographyHeadshotsOther
Please list any Agents/Brokers/Offices that you are currently under contract with.*
All agents/brokers must give permission before MLS access is granted.
Please upload your company logo here.*

Browse Files
Logo will be used in the Photographer directory Cancelof
Name*

First NameLast Name
Signature*

Clear
Please use a mouse or touchscreen to sign above.
Date*

MonthDayYear
Date
Please verify that you are human*
Having read this Agreement, Photographer assents to its terms by clicking “Register Now”.
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