* (required information)

* Applicant's Name	(* By typing my name I intend this to be my electronic signature and consent as requested by this form)
* Email Address
* License Type	Broker Salesperson Appraiser
* Home Address
* City		* Zip
* Office Name
* Office Address		* Zip
* Contact Phone (will be on your listings)
* Office Phone
Home Fax
Cellular Phone
I hereby submit the following information for NSBAR consideration:
Name as shown on license
Name to appear on roster
Nickname
License Number
Social Security #	- -
Name of business, if sole owner
Business Address		Zip
Website Address
Membership classification: DR-Designated REALTOR® (one per firm who is the owner, principal, partner, corporate officer) Manager-REALTOR® Agent-REALTOR® Appraiser
Do you hold, or have you held, a real estate license in any other state?
Yes No If yes, please specify name of state and license number:
Has your real estate license, in this or any other state, ever been suspended or revoked?
Yes No If yes, please specify the place(s) and date(s) of such action, and detail the circumstances relating thereto:
Are there now any pending or unresolved compliants, 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 or government?
Yes No If yes, please 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:
Have you ever been convicted of a felony?
Yes No If so, give the details, including state and court of conviction:
Are you currently a member of another board or association which is affiliated with the NATIONAL ASSOCIATION OF REALTORS® or have you held membership in another board or association within the past three (3) years?
Yes No If "yes," list each board and association where membership was held, type of membership held, and approximate dates of membership.
This section must be completed by applicants for REALTOR® Membership, whether primary or secondary, who are principals, partners, corporate officers, or branch office managers (i.e. individuals in positions of management control on behalf of individuals who are not physically present and engaged in the real estate profession). Agents, click here to complete your application
State the names and titles of all other principals, partners, or corporate officers of your firm.
Name:   Title: Name:   Title: Name:   Title:
List the names and addresses of all branch offices or other real estate firms in which you are a principal, partner, or corporate officer:
Name:   Address: Name:   Address: Name:   Address:
Tax ID number:
Sole Proprietor DBA Partnership Corporation
Position with firm:
Principal Partner Corporate Officer
This section is to be filled out by all membership classifications
Are you a member of an institute, society, or council affiliated with the National Association of Realtors?
Yes No If yes, please indicate name of affiliation
List below any professional designations you hold:

I hereby apply for REALTOR® membership in the above named board/association and enclose my payment, which I understand will be returned to me in the event I am not accepted for membership. If application is approved, I agree as a condition to membership to complete indoctrination course of the above named board/association WITHIN 90 DAYS from date of application or forfeit all fees, 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, constitution, bylaws, rules and regulations, and duty to arbitrate. I further agree that my act of paying dues shall evidence my initial and continuing commitment to abide by the aforementioned Code of Ethics, constitution, 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 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 NSBAR will maintain a membership file of information which may be shared with other boards/associations where applicant subsequently seeks membership. This file shall include: previous applications for membership; all final findings of Code of Ethics violations and violations of other membership duties within the past three (3) years; pending complaints alleging violations of the Code of Ethics or alleging violations of other membership duties; incomplete or pending disciplinary measures; pending arbitration requests; and information related to unpaid arbitration awards or unpaid financial obligations to the board/association or its MLS.

NOTE: Applicant acknowledges that if accepted as a member and he/she subsequently resigns from the board 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®.

NOTE: Dues payments to NSBAR are not tax deductible as charitable contributions. Portions of such payments may be tax deductible as ordinary and necessary business expenses.

* I understand that by providing my mailing address, email address, telephone number, and fax number, I consent to receive communications sent by or on behalf of the North Shore – Barrington Association of REALTORS® (and its subsidiaries and affiliates) via regular mail, email, telephone, or fax. I understand that NSBAR will not share my address/email/telephone/fax with other organizations but will with other members of NSBAR.

Information supplied is not required. However, it will assist us in establishing historical data regarding its members. Information furnished will not be used in evaluating an applicant’s qualifications for membership.

Place of Birth:
City or County: State:
Date of Birth: / /
Ethnic/national origin:
Languages Spoken:
Highest level of education completed:
First entered the real estate business:
Date: / / City: State:
Have you been engaged continuously in the real estate business since then?
Yes No If not, during what years were you active in real estate? to
How many years have you been active in the real estate profession
In what phase of real estate do you specialize?
In what other businesses have you been engaged?
	to , in the city of
	to , in the city of
	to , in the city of
First licensed in the state of Illinois on the date of:
/ / , and continously since
Established in present location on:
/ /
Last previous location:
Resident here since:
/ /
Previous residence:
City: County: State:
List the names of board committees on which you would be interested in serving (I.e. multiple listing, professional standards, finance, etc.)
Are you now employed by or engaged in any other business or profession?
Yes No