ATHENS AREA ASSOCIATION OF REALTORS, INC. 540 Prince Avenue Athens, Georgia 30601 Telephone: 706-353-1126 Fax: 706-354-0647 email address: abr@negia.net website: http://www.athensrealtors.net

Applying For (Circle One):   Primary   /   Secondary   /   MLS Only   Membership   Applicant Name:______________________ Company:_____________________________ Home Address:_______________________ Street Address:_________________________ ___________________________________ Mailing Address:________________________ Home Phone #: (_____) _____ - ________ Company Phone #: (_____) _____ - ________ Pager #: (_____) _____ - ________ Fax #: (_____) _____ - ________ Social Security No.:____________________ Date of Birth: _________________________ R.E. License #:_______________________ E-mail Address:_______________________ Have you taken the Code of Ethics Training? (Circle One)   Yes   /   No   If Yes, give date taken:____________ Do not write in the box below. For Board Use Only. Application Returned: ______ Paid: 300.00____ 550.00____ Check #:____ Date:_______ Received new member packet:_________________ Attended orientation_______ Board Dues Paid:___________ Amount $:___________ Check #:___________ Completed C.O.E. Training during Orientation:______________________________ DATE APPROVED BY BOARD OF DIRECTORS:______________________________     I acknowledge and agree that within three months or three consecutive Indoctrination Classes from the date this application is submitted to the Athens Area Assocation of REALTORS, Inc., that I will attend the Board's Membership Indoctrination Class. I understand that I will not receive any benefits of membership until all membership requirements have been satisfied. In the event that I fail to attend an Indoctrination Class as set forth above, this application and it's conditional approval shall expire and all dues and fees paid by me will be forfeited to the Athens Area Association of REALTORS, Inc. __________________________ _______________________________________________ DATE SIGNATURE     Application for Membership in a Board/Association of REALTORS SECTION I (Applications for primary, secondary, and Designated REALTOR membership and REALTOR-ASSOCIATE membership are required to complete Section I and Section II, if applicable. All other applicants sould proceed to Section III. Applications for MLS participation only should proceed to section VI.) TO: ATHENS AREA ASSOCIATION OF REALTORS, INC. Name of Applicant:____________________________________________________________ Residing At - Street:__________________________________________________________________ City:___________________ State:___________ Zip:______________ Phone: (_____) _____ - ________ I hereby apply for (REALTOR (primary, secondary, Designated)_________________________ membership in the above named Board, and enclose my check in the amount of $________________, which I understand will be returned to me in the event that I am not accepted to membership. In the event my application is approved, I agree as a condition to membership to complete the indoctrination course of the above named Board, if any, and otherwise on my own initiative to thoroughly familiarize myself with the Code of Ethics of the NATIONAL ASSOCIATION OF REALTORS, including the duty to arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the Board and the Constitution, Bylaws, and Rules and Regulations of the above named Board, the State Association and the National Association, and I further agree to complete satisfactorily a reasonable and nondiscriminatory written examination covering such Code, Constitutions, Bylaws, Rules and Regulations, and duty to arbitrate, all as from time to time amended. Finally, I consent and authorize the Board, through its Membership Committee or otherwise, to invite and receive information and comment about me from any Member or other person, and I agree that any information and comment furnished to the Board by any Member or other person in response to any such invitation shall be conclusively deemed to be privileged and not form the basis of any action by me for slander, libel, or defamation of character. NOTE: Applicant acknowledges that if accepted as a Member and he/she subsequently resigns or is expelled from membership in the Board with an ethics complaint or arbitration request pending, the Board of Directors may condition renewal of membership upon applicant's verification that he/she will submit to the pending ethics or arbitration proceeding and will abide by the decision of the Hearing Panel; or if applicant resigns or is expelled from membership without having complied with an award in arbitration, the Board of Directors may condition renewal of membership upon his/her payment of the award, plus any costs that have been established previously as due and payable in relation thereto, privided that the award and such costs have not, in the interim, been otherwise satisfied. NOTE: Dues payments to the ______________________________ Board / Association are not tax deductable as charitable contributions. Portions of such payments may be tax deductible as ordinary and necessary business expenses. BROKER'S SIGNATURE:__________________________________________________   I hereby submit the following information for your consideration: (Please PRINT) ( MR / MS ) Name as shown on license:____________________________________________________________ Name as you want it to appear on roster:____________________________________________________________ Nickname:____________________________________________________________ License Number:____________________________________________________________ Please Circle One: (Broker)_____(Salesman)_____(Other) Please Specify:______________________________ Social Security Number:_______________________________________________________ Tax I.D. Number:____________________________________________________________ Name of Firm:____________________________________________________________ Office Address - Street:_____________________________________________________ City:_______________ State:_______ Zip:_________ Phone: (_____) _____ - ________ Pleaes check the appropriate box to designate your mailing address:____Office ____Home Circle Whether: (Sole Proprietor) (DBA) (Partnership) (Corporation) State position with firm: (Principal) (Partner) (Corporate Officer) (OFfice Manager) (Employee) (Independent Contractor) (Other) If "Other", explain: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ I agree that, if accepted for Membership in the Board, I shall pay the fees and dues as from time to time established. Dated:______________________, ________ Signed:___________________________ (Applicant's Usual Form of Signature)   SECTION II This section must be completed by applicants for REALTOR Membership, whether primary or secondary or "designated," who are principals, corporate officers, or individuals in positions of management control on behalf of individuals who are not physically present and engaged in the real estate profession in connection with the firm's office located within the jurisdiction of the Board (e.g. branch office managers). ALL OTHER APPLICANTS SHOULD PROCEED TO SECTION III State the names and titles of all other principals, partners, or corporate officers of your firm: Name:__________________________ Address:_____________________________ Name:__________________________ Address:_____________________________ Name:__________________________ Address:_____________________________ Is the office address, as stated in Section I, your principal place of business? (Yes) (No) List the names and addresses of all branch offices or other real estate firms in which you are a principal partner or corporate officer within the jurisdiction of the Board: Name:__________________________ Address:_____________________________ Name:__________________________ Address:_____________________________ Name:__________________________ Address:_____________________________ Business and Credit References: General Account:_________________________ ___________________________________ (Name of Bank) (Account) Escrow Account:_________________________ ___________________________________ (Name of Bank) (Account) Others:__________________________ ___________________________________ (Name of Bank) (Account) Are you or is any real estate firm in which you are a sole proprietor, general partner or corporate officer involved in any pending bankruptcy or insolvency proceeding or have you or any real estate firm in which you are a sole proprietor, general partner or corporate officer been adjudged bankrupt in the past three (3) years? (Yes) (No) If "yes", specify the places and dates of such action, and detail the circumstances relating thereto (Attach additional pages if more space is needed): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ NOTE: Applicant acknowledges that if the applicant or any real estate firm in which the applicant is a sole proprietor, general partner, or corporate officer is involved in any pending bankruptcy or insolvency proceedings or has been adjusted bankrupt in the past three (3) years, the Board may require as a condition of membership that the bankrupt applicant pay cash in advance for Board and MLS fees for up to one (1) year from the date that membership is approved or from the date that the applicant is discharged from bankruptcy (whichever is later) or, in the event that bankruptcy proceedings are initiated subsequent to obtaining membership in the Board, that the member may be placed on a "cash basis" from the date that bankruptcy is initiated until one (1) year from the date that the member has been discharged from bankruptcy. Do you hold, or have you ever held, a real estate license in any other state? (Yes) (No) If "yes", specify (Attach additional pages if more space is needed): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Has your real estate license, in this or any other state, been suspended or revoked? (Yes) (No) If "yes", specify the place(s) and date(s) of such action, and detail the circumstances thereto (Attach additional pages if more space is needed): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Are there now any pending or unresolved complaints, or have there been within the past 3 years, any complaints against you or the firm with which you have been associated before any state real estate regulatory agency or any other agency of government? (Yes) (No) If "yes", specify the substance of each complaint in each state, the agency before which complaint was made, and the current status or resolution of such complaint (Attach additional pages if more space is needed): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Have you ever been convicted of a felony? (Yes) (No) If "yes", give details including state and court of conviction (Attach additional pages if more space is needed): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Please proceed to Section IV   SECTION III (Please indicate the category of membership to which you are applying and check the appropriate box next to home or business address, for mailing purposes) ___ Institute Affiliate ___ Affiliate ___ Public Service ___ Honorary ___ Student ___ Home Address:___________________________________________________ _______________________________________________________________ Home Phone: ____________________________________________________ ___ Business Address:_________________________________________________ _______________________________________________________________ Business Phone: __________________________________________________ Are you a member of an Institute, Society or Council affiliated with the NATIONAL ASSOCIATION OF REALTORS? ____Yes / ____ No If yes, please indicate the name of the affiliate: __________________________________________________ What professional designations, if any, do you hold? ____________________________________________________ ____________________________________________________ An applicant for Institute Affiliate Membership shall supply to the Membership Committee evidence that applicant holds a professional designation awarded by a qualified Institute, Society or Council affiliated with the NATIONAL ASSOCIATION OF REALTORS that addresses a specialty area other than residential brokerage or who otherwise holds a class of membership in such Institute, Society or Council that confers the right to vote or hold office and shall agree, if elected to membership, to abide by the Constitution, Bylaws and Rules and Regulations of the local Board, the State Association, and the National Association.   SECTION IV (All applicants must sign) 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 membership if granted. Signed_________________________________________________________________   INFORMATION SUPPLIED UNDER SECTION V IS NOT REQUIRED, BUT WILL ASSIST THE BOARD IN ESTABLISHING HISTORICAL DATA REGARDING ITS MEMBERS. INFORMATION FURNISHED UNDER SECTION V WILL NOT BE USED IN EVALUATING AN APPLICANT'S QUALIFICATIONS FOR MEMBERSHIP. SECTION V Place of Birth: ________________________________________________________     (City or County)     (State)     (County) Date of Birth:________________________________________________________ Ethnic/National Origin:___________________________________________________ Highest level of education completed:_________________________________________ First entered the real estate business: _____________________ at___________________ (Date) (city & state) Have you been engaged continuously in the business since then? ____ Yes / ____ No If not, during what years were you in the business?__________________________________ How many years have you been active in the real estate profession?_____________________________ ____ Salesperson / ____ Broker / ____Other:______________________________________________ In what other business have you been engaged? ________________________from (years)_______ to _______, at (city)_________________ ________________________from (years)_______ to _______, at (city)_________________ ________________________from (years)_______ to _______, at (city)_________________ ________________________from (years)_______ to _______, at (city)_________________   First licensed in this State _________________________ in (year)________, and continuously licensed since (date) __________________________ Established in present location since (date)_________________________________ Previous location:___________________________________________________________ Resident here since:__________________________________________________________ Previous residence (city or county and state):_______________________________ Are you a member of any other real estate board whether or not affiliated with the NATIONAL ASSOCATION OF REALTORS? ____ Yes / ____ No Name of Board:_____________________________________________ If "Yes', list each other such Board, type of membership held, and dates establishing the time period for which membership has been held: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Have you participated in a Multiple Listing Service? ____ Yes / ____ No Where? __________________________________________________________________ List the names of board Committes on which you would be interested in serving (e.g., Multiple Listing, Professional Standards, Finance, etc.): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Are you now employed or engaged in any other business or profession? ____ Yes / ____ No _________________________________________________________________________ (position and location)