Hopkinsville Imagine MLS Participant (Principal Broker) Application

Name:

Name as you want it to appear in the roster

Office Affiliation

Office Address

Office Phone

Office Fax

Office City

Office State

Office Zip

Home Address

Home City

Home State

Home Zip

Date of Birth

Last 4 of SSN

Website

Email Address

License Number

Cell Phone Number

Alternate Phone Number

Have you been a member of Bluegrass Realtors (formerly LBAR) in the past?

Yes

Where is your current primary membership?

Please include your NRDS (National Realtor Data System)/M1 number

Do you speak a second language - if yes, please indicate which language(s) you speak

Are you aware that your services will be suspended if you fail to complete the required orientation class(es)?

Yes, I understand

I have read and understand the MLS Rules and Regulations.

Yes, I read and understand

I understand that all fees and dues are NON-REFUNDABLE

Yes, I understand

Questions? Comments?