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*
Format: (000) 000-0000.
Email*
example@example.com
YesNo
YesNo
Membership Level*
MediaGold Coast SchoolsNew Licensee ProgramAgentBrokerBrokerageOther
Website or Social URL*
BrowardPalm BeachSt. LucieMartinMiami-DadeIndian River-Okeechobee
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*

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”.
Should be Empty: