Commercial Real Estate Alliance Membership Application This application is for licensed Indiana brokers who wish to join the Commercial Real Estate Alliance. Please note: REALTORS®, or those wishing to become a REALTOR®, must apply using the REALTOR® membership application. Applicant InformationName* First Last Designations (i.e. CCIM, SIOR, CPM) Date of Birth* Date Format: MM slash DD slash YYYY Real Estate License Number*Appraisal License Number (if applicable)Your Email* Why are you applying for membership?*Industry ConnectionsICREXConference/EducationOffice InformationOffice Name*Company Information* Corporation LLC Partnership Sole Proprietor Other Office Physical Address* Street Address Address Line 2 (i.e. suite number, floor) City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your office's mailing address the same as the physical address?*YesNoOffice Mailing Address* Street Address Address Line 2 (i.e. suite number, floor) City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Phone*Home/Cell PhoneIs the office address, as stated, your primary place of business?*YesNoIf not, or if you have any branch offices, please indicate and give address: Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Mailing*Member communications, including your annual dues invoice will be sent here.HomeOfficePreferred Phone*HomeOfficeDoes CREA have permission to share your contact information in the membership directory?*YesNoYour Position* Managing Broker/Principal Broker Branch Manager Corporate Officer Partner Majority Shareholder Managing Broker's Name*Names of other Partners/Officers of your firm:Additional InformationDo you hold, or have you ever held, a real estate license in any other state?*YesNoWhere?Have you been found in violation of state real estate licensing regulations with in the last three years?*YesNoDetails:*Have you been convicted, adjudged, or otherwise recorded as guilty by a final judgement of any court competent jurisdiction of a felony or other crime?*YesNoDetails:**I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Alliance, I shall pay the fees and dues as from time to time established. NOTE: Payments to CREA are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. Dues are not refundable or transferable. By signing below I consent that CREA and their subsidiaries, if any (e.g., CIE, Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Alliance in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership. Also, applicant consents that the Alliance may invite and receive information and comment about applicant from any Member or other persons, and that applicant agrees that any information and comment furnished to the Alliance by any person in response to the invitation shall be conclusively deemed to be privileged and not form the basis of any action for slander, libel, or defamation of character. Signature Date To complete your application, please hit submit and continue to the payment form on the next page. Both the application and payment must be received in order to process your application.
