Today's Date:

For The Space Coast Association of REALTORS®, Inc
105 McLeod St, Merritt Island, FL 32953 
Phone: 321-452-9490  Fax: 321-452-1108 

To download & print out the application instead, click here  

I hereby apply for REALTOR membership in the above named Association and am enclosing payment in the amount of $300 for the one time application fee, $  for dues (prorated monthly) and $  for MLS for  , payable to the Space Coast Association of REALTORS®. Total amount due is $ .
  
I understand my application fee and dues are non-refundable. In the event the Association does not accept my membership, fees and dues will be refunded. In the event of election, I agree to abide by the Code of Ethics of the National Association or REALTORS®, which includes the duty to arbitrate, and the Constitution, Bylaws and Rules and Regulations of the above named Association, the State Association and the National Association, and if required, I further agree to satisfactorily complete a reasonable and non-discriminatory examination on such Code, Constitutions, Bylaws and Rules and Regulations.
  
I understand membership brings certain privileges and obligations that require compliance. Membership is final only upon approval by the Board of Directors, and may be revoked should completion of requirements such as orientation not be completed within timeframe established in the association’s bylaws. I understand that I will be required to complete periodic Code of Ethics training as specified in the association’s bylaws as a continued condition of membership.
  
Applicant acknowledges that if accepted as a member and he/she subsequently resigns from the Association or otherwise causes membership to terminate with an ethics complaint pending, the Board of Directors may condition renewal of membership upon applicant’s certification that he/she will submit to the pending ethics proceeding and will abide by the decision of the hearing panel. If applicant resigns or otherwise causes membership to terminate, the duty to submit to arbitration continues in effect, even after membership lapses or is terminated, provided the dispute arose while applicant was a REALTOR®. I hereby submit the following for your consideration:

First Name:
Last Name:
Residence Address:
City:
State:
Zip Code:
Phone ex xxx-xxx-xxxx:
Cell Phone:
Email Address:
Web Address:
Last 4 of Social:
License Number:
License Type:
MLS Password (up to 8 characters):
Office Name:
Office Address:
City:
State:
Zip:
Phone ex. xxx-xxx-xxxx:
Preferred Mailing:	- Select One - Home Office
Preferred Contact:	- Select One - Cell Office Phone
Are you presently a member of another Association:	- Select One - No Yes
If yes, name of Association and type of membership held:
Have you been found in violation of the Code of Ethics or other membership duties in any Association of REALTORS® in the past 3 years or any such
complaints pending:	- Select One - No Yes
(If yes provide explanation) :
Optional Information:
Date of Birth (xx/xx/xxxx):
Birth Place:
Speciality:	Commercial International Other Residential Resort
Are you now employed in another profession:	- Select One - No Yes
If yes, position and location:
I certify that I have read and accepted the terms of this application:	*
Please enter the text shown in the graphic below
Text:

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 other misstatement of fact, shall be grounds for revocation of my membership if granted.