Lufkin Association of Realtors

Personal Information

First Name: *

Last Name: *

Address: *

Address2:

City: *

State: *

Zip: *

TREC License No:

Title:

Primary Contact #:

Email:

Date of Birth: Month/Day/Year:

Additional Information

Are you a Primary member of any other Board of REALTORS?:

Yes No

If so where?:

NRDS #:

Have you previously held membership in any other Board of REALTORS?:

Yes No

If so where?:

NRDS #:

Have you ever been denied membership or been expelled by any Board of REALTORS?:

Yes No

If so why?:

Have you ever been found in violation of the Code of Ethics or other membership duties in any Association of REALTORS® in the past three (3) years or are there any such complaints pending?:

Yes No

If yes, please explain.:

Specialty:

Are you interested in serving on any of the following LAR Committees?:

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Box Value:

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Company Information

Personal Information

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