230 W. Towne Ridge Parkway, Ste. 100, Sandy, Utah 84070 Phone: 801-542-8840 Email: assistant@slrealtors.com BROKER APPLICATION
INSTRUCTIONS
1. Please download, fill, save, and electronically submit this application to assistant@slrealtors.com.
2. You can include payment information above, or we will email payment instructions to you after we receive your application.
3. When payment is confirmed and authorized, we will send a welcome email with important membership information.
PLEASE SELECT YOUR BROKER TYPE
SECTION 1 REALTOR® INFORMATION
ARE YOU CURRENTLY A MEMBER OF ANOTHER REALTOR® ORGANIZATION? Yes No
(IF YES) PRIMARY REALTOR® ASSOCIATION NAME: _______________________________________________________________________________
NATIONAL REALTOR® (NRDS) #: _____________________________ UT DIVISION OF REAL ESTATE LICENSE #: _______________________________
DUES WAIVER FROM PRIMARY ASSOCIATION ENCLOSED: Yes No N/A
SECTION 2 PERSONAL INFORMATION
FIRST NAME: ____________________________ MIDDLE NAME: _____________________ LAST NAME: __________________________________
PHONE: ____________________________________________ HOME CELL WORK OTHER
EMAIL ADDRESS: _________________________________________________________________ BIRTHDATE: _____________________________
HOME ADDRESS: __________________________________________________________________________________________________________
CITY: ________________________________________ STATE: ____________________________
ZIP: ________________________________
Other: _____________
_____________________________
V
E
TE
R
AN: Yes No
LANGUAGES SPOKEN: English Spanish Mandarin
GENDER: Male Female Non-binary
COMPANY NAME: _________________________________________________________________________________________________________
COMPANY PHONE: ____________________________________________ HOME CELL WORK OTHER
COMPANY ADDRESS: _______________________________________________________________________________________________________
CITY: ________________________________________ STATE: ____________________________ ZIP: ________________________________
Payment Type: VISA MC AMEX DISC
Card Number:
Expires: _______ /_________
_________________________________________
CARD HOLDER SIGNATURE
BROKER APPLICATION
Join as a PRINCIPAL BROKER (Designated Realtor®)
Join as a BRANCH BROKER
Join as a SECONDARY BROKER (Must provide a dues waiver from your Primary Realtor® Association)
SECTION 3 BROKERAGE INFORMATION
230 W. Towne Ridge Parkway, Ste. 100, Sandy, Utah 84070 Phone: 801-542-8840 Email: assistant@slrealtors.com BROKER APPLICATION
MEMBERSHIP AGREEMENT
If my
application is approved, I, the undersigned, agree to the following (please initial each box and sign below):
I understand that the primary form of communication for the Salt Lake Board of Realtors®
is email. I agree to check my email often so that I
don’t miss important Board communications, and will promptly notify the Board of any changes to my email address or other contact
information.
I agree to complete the required Code of Ethics and Realtor Essentials courses (if applicable), as well as any other course the Board may
require, within 60 days of joining the Board, or as otherwise specified by the Membership Department. I acknowledge that failure to
complete all required courses will result in the termination of my membership and forfeiture of my dues and application fee.
I agree to become familiar with the Code of Ethics, as well as the bylaws of the Salt Lake Board of Realtors®, which can be found on the
Board website. I will also familiarize myself with the rules and regulations of the Utah Association of Realtors® and the National Association
of Realtors®. The annual renewal of my membership shall indicate my continued commitment to abide by the aforementioned standards
as they are amended from time to time.
I acknowledge that if I become a Board member and then subsequently resign, or cause my membership to be terminated, with an ethics
complaint pending, future reactivation may be conditioned upon my compliance with any ethics hearing determinations.
I acknowledge that if I become a Board member and then subsequently resign, or otherwise cause my membership to be terminated, the
duty to submit to arbitration continues in effect even after my membership resignation/termination, provided the dispute arose while my
membership was active.
I understand that it is my yearly duty to submit a complete list of all individuals licensed or certified in my office to the Board and to
identify the primary board for each individual who holds a Realtor® membership. I will identify any Non-Member licensees in my office and
indicate whether or not Non-Member dues have been paid to another board. If said Non-Member dues have not been paid, I recognize
that it is my duty to pay them. I understand that these declarations will be used to calculate dues under Article X, Section2(a) of the
bylaws.
I understand that I must notify the Board of any additional individual(s) licensed or certified with my brokerage within 30 days of the
individual’s date of affiliation. Failure to notify the Board will result in a fine for unreported licensees (currently $50, but subject to annual
review by the Board of Directors). Failure to pay this fine will be treated under the provisions of Article X, Section 4 of the bylaws.
I agree to pay my annual renewal dues each June, in the amount specified to me by the Board. I understand that dues are subject to
review and possible change annually. I recognize that dues are non-refundable, and that once paid, they become the property of the
Board. If I do not renew, or my membership is terminated, I will immediately cease to represent myself as a Realtor®.
I acknowledge that if I discontinue my Board membership, it is my duty to inform all agents in my office of the necessity to place their
licenses with a different member brokerage in order to retain their Board memberships.
I understand that the termination of my membership for non-payment of annual dues (or for any other reason) will result in a $350 re-
entry fee to be paid upon possible future reactivation with the Board.
I consent that the Salt Lake, Utah, and National Association of Realtors® and their subsidiaries, may contact me using the information
provided on this form, or by other available means of communication. This consent extends to possible future changes in contact
information. I waive any limits placed on communication by certain state/federal laws in order to receive all membership communications.
APPLICANT SIGNATURE: ___________________________________________________________ DATE: _________________________