MLS Only Designated Broker Participant Application Form

MLS Only Designated Broker Participant Application
Name (As it appears on license)

First NameMiddle NameLast NameSuffix
Nickname if applicable (Nickname must be on file with MREC)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:
Website:
Cell Phone Number:
Office Phone Number:
License or Permit Number:
License Issue Date:

MonthDayYear
Date
Office/Brokerage Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
License Type:

SalespersonBrokerBroker SalespersonBroker AssociateBroker OfficerAppraiser
Birthdate

MonthDayYear
Date
Languages
Membership Classification

REALTOR®Designated REALTOR®AppraiserDesignated AppraiserSecondary REALTOR®Secondary Designated REALTOR®Secondary AppraiserSecondary Designated Appraiser
Primary Field of Business

ResidentialCommercialIndustrialLandAppraisalOther
Work Experience
Interests
Hobbies

Please enter the name of the REALTOR® Association in which you currently hold Primary Membership.
Orientation and MLS Login Information
REQUIRED New MLS Member Online Training Course (Orientation is required to be completed within 60 days of your join date)

You will receive your orientation training link and MLS login once your application has been received and processed.
Please Note: All other Membership details and login credentials will be sent via email following receipt of all new member dues payments.
I, hereby agree as a condition of participation in the Multilist Service of Springfield REALTORS®, Inc. to abide by the Bylaws, Rules and Regulations of the Service, and other obligations of participation including payment of fees. I further agree to be bound by the National Association of REALTORS® Code of Ethics including the obligation to submit to ethics hearings and the duty to arbitrate contractual disputes with other REALTORS® in accordance with the established procedures of the Board/Association. I understand that a violation of the Code of Ethics may result in termination of my MLS priveleges and that I may be assessed an administrative processing fee of up to two hundred fifty ($250), which may be in addition to any discipline, including fines, that may be imposed.

I irrevocably waive all claims againts the Multilist Service or any of it's officers, directors, staff or members for any act in connection with business of the Multilist Service and particularly as to it's or their acts in electing or failure to elect, advancing, suspending, expelling or otherwise disciplining me as an applicant or as a member.

NOTE: MLS Broker Application Fee is $500. If paid by check, please make check payable to MLS of Springfield. All Fees are Non-Refundable and Non-Transferrable
I acknowledge that failure to complete the mandatory New Member Online training course can result in the denial of my membership application and termination of my MLS access.
Signature

Clear
Date

MonthDayYear
Date
Do you have additional agents licensed with your brokerage?*

YesNoNot now but will
Should be Empty:

MLS Only Designated Broker Participant Application

Orientation and MLS Login Information