Independent Contractor Agreement Real Estate New York by dog18452

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									Application Rec’d ______/______/______ Provisional Accepted ______/______/______                  Orientation Attendance ______/______/_____

NRDS #                                            M LS User Name:                                 Assigned Password:



                     BERKSHIRE COUNTY BOARD OF REALTORS®, INC.
                      REINSTATEMENT FOR RE ALTOR® MEMBERS HIP
REA LTOR® Membership can be reinstated within one (1) calendar year. A reinstatement fee applies and dues for the
current calendar year must be paid in full, and are not prorated.



                                                 ME MB ER INF OR MA TION
Full Name as it appears on license:
Salutation:          Ms.           Mrs.            Mr.           Dr.         Nickname:


AGENT CONTACT INFORMATION                                                  OFFICE CONTACT INFORMATION

Name for Roster:                                                           Office:
Ho me Address:                                                             Designated REA LTOR:
Apt / Care of:
                                                                             I, the undersigned Designated REALTOR® (DR) of the above
City:                                   State:         Zip:                  named company, confirm that the licensed real estate agent
                                                                             listed here is affiliated with my real estate firm and I accept
Ho me Phone:         (         )          -                                  oversight responsibility for their actions in connection with all
                                                                             governing documents of the Berkshire County Board of Realtors
Personal Fax:        (         )          -                                  and M ultiple Listing Service. [DR to Signature Required]
Mobile or Cell:: (             )          -
E-Mail:                                                                      
Preferred Mailing Address:              Ho me - or -      Office           Add’l Phone #’s to appear on roster          Ho me        Mobile

REAL ESTATE LICENSE HISTORY
1.   License #                                                Exp Date                        Type:        Bro ker     Sales         Appraisal
2.   Do you hold, or have you ever held, a real estate license in any other state? If yes, please specify:
3.   Has your real estate license, in this or any other state, been suspended or revoked?                                      Yes       No
4.   If “yes”, specify the place(s) and date(s) of such action, and detail the circu mstances relating thereto:


REALTOR® MEMB ERSHIP INFORM ATION: Membership ID, if known

5.   Birth Date:           /        /                Social Security #:            -          -            .
                                          ®                                   ®
6.   Member Type:          REALT OR                      Designated REALT OR (Broker/ Principal responsible for all office obligations)
7.   Office Status:        Principal/Partner             Office Manager           Emp loyee          Independent Contractor
                 ®
8.   REALT OR Membership Type                            Primary Member           Secondary* (must hold current membership elsewhere)
                                              ®
9.   Do you currently hold REALTOR membership in any other Association?                               No       Yes
     If yes, please specify
REALTOR® MEMB ERSHIP INFORM ATION CONTINUED…
10. Have there been any complaints/cases against you before any real estate association, state real estate regulatory agency
    or any other agency of government within the last three years?    No       Yes – If yes, specify the substance of each
    complaint in each state, the agency before which comp laint was made, and the current status or resolution of such
    complaint:


11. Have you ever been convicted of a felony?         No      Yes - If yes, please give details including state and court of
    conviction:

PROFESSIONAL INFORM ATION:
Note: Th is information is not used to assess your membership qualificatio ns. It is simp ly to allow the Board of REALTORS®
to tailor our services and promotional efforts for your specialties. You can change or update this information at any time b y
contacting the Board office. You do not need to complete this section for membe rship consideration.

12. Professional Designation or Degrees held:

13. Year first entered Real Estate Business:                     City / State:

14. Have you been engaged continuously in the business since then?  Yes, at least part-time since licensed   No, stopped
    or never actively practiced real estate – or - Occasionally engaged in real estate when circu mstances permitted.

15. Other Profession/ Business Experience:

16. Are you now engaged in any other business?         No, not at this time      Yes: (Position)

17. Resident here since         Previous residence:

18. Do you hold any governmental positions         No, not at this time       Yes: (Position)

19. Do you currently belong to any organizations? (ie: business, civic, charitable or other)

20. Do you hold any leadership roles in other organizations?        No, not at this time        Yes: (Position)

21. Would you like mo re informat ion on the benefits of serving in volunteer leadership? If yes, your interests:
        Education         Housing Opportunities       Government Affairs         Professional Standards           Co mmun ity Serv ice

22. Business Area: Check all that apply:
        North Berkshire                           Central Berkshire                             South Berkshire
        New Yo rk / Connecticut / Vermont         Pioneer Valley                                Other:

23. Professional Specialties: Check all that apply
       Residential Sales                         Residential Rental                             Condominiu ms
       Land / lots                               Co mmercial                                    Other:

24. Bro kerage Type Offered:
        Buyer and Seller Representation           Exclusive Buyer Representation                Exclusive Seller Representation
        Transactional Brokerage                   Limited Service                               Other:

25. Are there any other interests, accomplishments or skills you possess that you would like to share with us?




                                                                                                                             Page 2 of 4
       MEMB E RSH IP AG R EEM E N T – AL L APPLIC AN TS MU ST C OMPL E TE

I hereby apply for REALT OR® membership in Berkshire County Board of Realtors, and enclose payment in the amount of…

$ 50.00 R EINSTATEMENT FEE AND                   $_         _ _ DUES = $__                  __ TOTAL PAID

…which I understand will be returned to me in the event I am not accepted to membersh ip. In the event my applicat ion is
approved, I agree as a condition to membership to comp lete one of the next two Orientation programs offered by the
Berkshire County Board of REALT ORS®. I ag ree to, upon my own in itiative, thoroughly familiarize myself w ith the Code of
Ethics of the Nat ional Association of REALT ORS® and with the governing documents of the Board of REALT ORS®, which is
continually availab le on the Board’s website www.BerkshireRealtors.com. I further agree to comp lete satisfactorily a
reasonable and nondiscriminatory written examination covering such Code, Constitutions, Bylaws, Rules and Regulations
and duty to arbitrate.

I agree that my act of paying dues shall evidence my in itial and continuing commit ment to abide by the aforementioned Code
of Eth ics, Constitutions, Bylaws, Ru les and Regulations, and duty to arbitrate, all as fro m time to time amended. I consent
and authorize the Board, through its Membership Committee or otherwise, to invite and receive information and com ment
about me fro m any Member or other person, and I agree that any informat ion and comment fu rnished 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 defamat ion of character.

NOTE: Applicant acknowledges that if accepted as a Member and he/she subsequently resigns or is expelled fro m
membership in the Board with an ethics comp laint or arbit ration request pending, th e Board of Directors may condition
renewal o f 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; o r if applicant resigns or is expelled fro m membership without having
complied with an award in arbitrat ion, 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, pro vided that the
award and such costs have not, in the interim, been otherwise satisfied.

NOTE: Dues payments are not tax deductible as charitable contributions. Portions of such payments may be tax deductible
as ordinary and necessary business expenses. Dues will be pro-rated according to each Association’s bylaws.

Applicant acknowledges that this application must be administratively approved before Provisional Membership is activated.
Applicant further understands that they will receive two opportunities to attend a mandatory, full-day orientation program.
Provisional membership will either be amended to “Full REA LTOR®” status upon completion of the program or be
terminated for non-attendance. In the event provisional membership is terminated, no re funds will be provided.
Additionally, submission of a new application and application fee will be required to reapply for provisional membership and
current year dues, if not already remitted, will be due and payable.

Further, I agree that, if accepted for Membership in the Board, I shall pay the fees and dues as from time to time established.

I hereby certify that the foregoing informat ion 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 if granted.

SIGNATURE: ____________________________________                                            DATE: ____/____/____




         PLEAS E A TTAC H A CO PY O F
         CURREN T R EAL ES TATE O R
         APPRAIS AL LIC ENS E HER E




                                                                                                                       Page 3 of 4
       PROCESS F OR RE INS TA TIN G REAL TOR® ME MB ERS HIP
The Board Office will verify that your membership in the Berkshire County Board of REALTORS® was terminated not less
than one year ago and will establish Massachusetts real estate licensing informat ion. After that time, you will be assigned a
new sign-on and password for the M LS system and your REA LTOR® services will be activated.

The Board Office will send you this information and at that time, you can chose to install the ProMatch MLS software,
access forms on-line and your membership ID will be reinstated for use on all of the REA LTOR® websites.



                      Credit Card Authorization Form, if desired

The Berkshire County Board of REALTORS® can hereby charge the following credit card for:

An Application Fee, in the amount of .......................$50.00
Prorated Membership Dues in the amount of ............$                               * see below for matrix
For a Total of : ..........................................................$


Credit Card:              Discover                    American Express                 Master Card             Visa

Credit Card #                              /                       /                       /

Expiration Date:                 /

Name as it appears on Card:

Signature of Card Holder:

                            2009 BERKSHIRE REAL TOR® DUES
                                               Dues 2009:         Jan-Dec Full Year Dues

                                           Local: (Berkshire)             $172.00
                                           State (Mass.)*                 $138.00
                                           National (NAR)*                $115.00
                                           Total 2009 Dues:               $425.00



* Note: Secondary REALTOR® members need only pay local dues and application fee, with proof (letter in good standing)
of membership with another local association in Massachusetts or with a loca l and state association contiguous to Mass.




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