LoCAR Realtor Application

* Applicant’s First Name (as shown on license)

* Applicant’s Last Name

Real Estate License Number

* Date of Birth

* Office Name

* Home Address

* Home City

* Home State

* Home Zip

* Office Address

* Office City

* Office Zip Code

* Cell Phone Number

Home Phone Number

Office Phone Number

Fax Number

* Email Address

* Preferred Contact Number

Office
Cell
Home

If your preferred mailing address is different from your home address (i.e. PO Box or Office), please provide the address.

* Have you ever been a member of another Association of REALTORS?

Yes
No

If yes, please provide the Association name, dates of membership and your NRDS number

* Primary field of business (select one)

Primary field of business (Other) Please specify if you selected "Other"

Secondary Field of Business (from list above or specify)

I hereby apply for REALTOR membership in the Lower Columbia Association of REALTORS®. I agree to complete the orientation course of the Lower Columbia Association of REALTORS®. I further agree that my act of paying dues shall evidence my commitment to abide by the Code of Ethics, Standards of Practice, and Bylaws of the Lower Columbia Association of REALTORS®, Washington REALTORS®, and National Association of REALTORS®.

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.

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