The undersigned hereby applies for Associate
Membership in
The Real Estate Board of New York, Inc.

and subscribes to the Constitution and By-Laws of said Board and the Rules and Regulations governing the same, accepting and agreeing to be subject to them as they now exist or as they may be hereafter amended.

The applicant agrees to pay the annual membership dues of an Associate Member as designated in the schedule herein contained.

Signature of Applicant ___________________________________________________________________
(individual)

Firm or Corporation _____________________________________________________________________

By _________________________________________________________

Business Address _________________________________________________ Zip Code____________

Telephone _____________________ Fax:____________________email:____________________________________

Have you ever been convicted of a felony or pleaded guilty to such an offense? Yes No

If yes, please explain________________________________________________________________

Have you ever been convicted of a misdemeanor with respect to fiduciary responsibilities? Yes No

If yes, please explain________________________________________________________________

___________________ Partners

Have you held membership previously in this Board? yes no

Indicate with an x whether the membership is to be in the name of the individual or the company, co-partnership,
corporation or estate names in the application

(The owner of record assumes full responsibility for the payment of dues and all other obligations.)

Individual Company, co-partnership, corporation or estate