990 Washington Street
Dedham, MA 02026
APPLICATION FOR DESIGNATION
A candidate must be a member in good standing of the MBREA. Proper attitude, interest, attendance
and participation in MBREA meetings, functions and activities are considered important criteria.
Designation Category Sought: ¨RA ¨MRA
City: State: Zip:
Telephone: Fax: Email:
1. Real Estate Appraiser License Held: ¨Certified Residential ¨Certified General
2. States Licensed in: ¨MA ¨CT ¨ME ¨NH ¨RI ¨VT ¨Other:
3. Real Estate license held, if any: ¨Salesman ¨Broker License Number:
4. Professional appraisal designations held, if any: Number of years in profession:
5. I devote % of my time to the practice of real estate appraising.
6. Qualified as an expert on real estate in the following courts:
7. Please list type of properties:
8. I am available for: ¨fee assignments ¨court testimony on: ¨industrial ¨commercial ¨residential
9. I ¨ have or ¨ have not been subject to disciplinary action by a state licensing authority.
Highest level of formal education:
Name of Institution:
Year Graduated: Degree:
Non-MBREA sponsored real estate appraisal courses completed. Please attach documentation indicating
successful completion of non-MBREA sponsored classes that you wish to have considered as satisfying
COURSE NAME SPONSOR LOCATION DATE
Please list five MBREA sponsored functions, seminars, or courses you have attended in the past five years:
BUSINESS ASSOCIATIONS: On a separate attached sheet, list the names of all companies, business organizations and
associations with which you are connected as a member, director or officer, together with your title in each.
NON-BUSINESS ORGANIZATIONS: On a separate attached sheet, list the names of all non-business organizations,
such as professional societies, clubs, etc., with which you are affiliated, and your title in each.
I, _______________________________________, the undersigned, hereby apply for Designated Membership in the
MASSACHUSETTS BOARD OF REAL ESTATE APPRAISERS. In making this application, I hereby agree to bind myself
I hereby irrevocably waive any claim or right of action at law or in equity that I might have at any time hereafter against
the Massachusetts Board of Real Estate Appraisers, its officers, committee members, trustees, or other officials, either
as a group or as individuals, for any official act in connection with the business of the Board, and particularly as to its or
their acts in: (a) admitting or failing to admit me to Designated Membership in the Board; (b) disciplining me as a
member for infraction of the Massachusetts Board of Real Estate Appraisers' Rules of Professional Conduct, Bylaws or
It is agreed that any certificate, emblem or other evidence of membership in the Board which may be issued to me shall
at all times remain the property of the Board, held by me in trust, and will be returned to the Board upon demand by its
officers, if and when, for any reason, my membership in the Board is terminated.
In submitting this application, I state to the Board that there are no outstanding judgments, law suits, bankruptcies or
receivership actions pending against me nor any other form of material challenge to my responsibility, character, or
integrity, except as explained in the attached statement.
I am attaching my non-refundable check in the amount of $125 which is the application for designation fee. If awarded
designation, I will forward dues in accordance with the current requirements of the Board of Trustees, and in the amount
specified by said Trustees.
IN WITNESS WHEREOF, I hereby set my hand and seal.