NRDS Number *

If you aren't sure, you can find your NRDS# at this link:

https://login.connect.realtor/#!/forgotmember

First Name *

Last Name *

Date of Birth: *

Email *

Phone

Firm Name *

What is your current primary state REALTOR® Association? *

What is your current primary local REALTOR® Association? *

Address Line 1 *

Address Line 2

City *

Postal Code *

Is your mailing address the same as your residence address? *

Yes

No

Please upload a letter of good standing from your current association. *

File must be a .PDF .Doc or .Docx

I agree that all information provided in this form is true and accurate to the best of my knowledge. *

Date Effective: *

Additional Comments