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Rutland County Board of REALTORS®, Inc.
Nora Moore, Association Executive
P. O. Box 1008
Rutland, VT 05702-1008

PLEASE COMPLETE THIS FORM OF REQUIRED FIELDS FOR THE MEMBER FILE LAYOUT FOR ENTRY INTO THE MULTI-BOARD MANAGEMENT SYSTEM

The following fields are required for every member

Last Name: _______________________________________________________________________

First Name: _______________________________________________________________________

Social Security Number: ____________________________________

Home Address: _____________________________________________________________________

Home City: Home State: Home Zip: _______________________________________________________

Mailing Address: Including City, State, Zip: ________________________________________________

Home Telephone- Including Area Code: ______________________________________________

Home Fax: Including Area Code: ___________________________________________________

Prefer Mail Sent to Office:________________________Home:___________(check one)

Prefer Publications sent to Office:__________________Home:___________(check one)

Name: ______________________________________________________

E-Mail Address: ________________________________________________

Web Page Address: ______________________________________________

Date First Licensed in Vermont:            VT Real Estate License Number
_________________________        __________________________


Date Joined REALTORS® Association: _________________________________________

Board Affiliations:
Primary Board Affiliation:

______________________________________________
Primary State Affiliation:

______________________________________________
Secondary Board Affiliation if any:

______________________________________________
Secondary State Affiliation if any:

______________________________________________
Secondary Board Affiliation if any other:

______________________________________________
Secondary State Affiliation if any other:

______________________________________________
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