Date: ____________________
The undersigned hereby applies for Corporate Executive 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 a Corporate
Executive 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________________________________________________________________
Principal Business__________________________________________________________________
Representative_____________________________________________________________________
(individual to be designated by corporation or firm as Board representative)
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