Welcome to ECBOR - Affiliate Application Form

The Voice for Real Estate in Elkhart County

57225 Alpha Drive
Goshen, Indiana 46528-7805
574.875.3283 Phone • 574.875.7174 Fax
Info@ecbor.com E-Mail

Application for Affiliate Membership in ECBOR

If you prefer to fax or mail your application, please click here for a printable form in PDF format.

Affiliate Membership Fees - Individual: $125.00 application fee	$200.00 dues pro-rated quarterly
Corporate Membership Fees - Primary Member $125.00 application fee	$200.00 dues pro-rated quarterly
Corporate Membership Fees - Additional Members: Application fee waived	$125.00 dues pro-rated quarterly
Please complete all entries.

Name:
Name of Firm:
Firm Address :
City, State, Zip:
Office Phone :
Voice Mail :
Fax:
E-Mail:
Your Title :
Principal Business of Firm:
Reason for joining:
Do you have an Indiana real estate license?	Yes No
Are you actively engaged in the real estate business?? If yes, please submit an additional page (numbered 13) in Word format via e-mail, mail or fax and explain in full.	Yes No
Have you ever been a member of this Board?	Yes No
If yes, what years?	Please list the year(s) separated by commas.
Has your membership in a Board of REALTORS® ever been refused, suspended, or terminated (voluntarily or involuntarily)? If yes, please submit an additional page in Word format via e-mail, mail or fax and explain in full.	Yes No
Are you applying to meet the requirements for membership in one of the Institutes, Societies or Councils of the National Association of REALTORS?®	Yes No
Will be doing business in:	Elkhart County St. Joseph County
I hereby apply for Corporate Individual membership in the Elkhart County Board of REALTORS®, Inc. and by doing so agree that I: Will submit the application fee of $125.00 and pro-rated dues by mailing the same to the Elkhart County Board of REALTORS®, 57225 Alpha Drive, Goshen, Indiana 46528-7805. (Application fee will be refunded if not elected to membership. Application will not be processed until the application fee is received.); Consent to the Board's authorized representatives inviting and receiving comments about me from any member or other person; Agree that any information received in connection with this application shall be conclusively deemed to be priviliged and not form the basis of any civil action by me (slander, libel, defamation, fradulent misrepresentation, invasion of privacy, etc.); Waive, irrevocably, any and all claims against the Board, its officers, directors and members for failing to elect me to membership; Certify that the information provided in this application is true and correct; Understand that failure to provide complete and accurate information or any misstatement of fact will be grounds for termination of membership should it be granted; By typing my name below, authorize the Elkhart County Board of REALTORS® to fax any material advertising the commerical availability or qaulity of any property, goods, or services deemed appropriate by the Elkhart County Board of REALTORS® to the fax number of ECBOR at (574) 875-7174. By typing my name below, I understand that this will have the same effect as my handwritten signature.
Date: 00/00/0000 format, please.	Type Name:
Please make sure you have completed all entries. Don't forget to remit your application, application fee and pro-rated dues and any addition documentation required by Items 11 and 13; your application cannot be processed until all information is and payment is received.

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