Life Service Member Application Form

Name
First Last
Firm Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Name of local Board/Association
QUALIFICATIONS
Member of Oregon REALTORS® for not less than twenty-five (25) cumulative years:
Member since:
Must be at least sixty-five (65) years of age, or have experienced a permanent health disability:
Birth Date:
Date Format: MM slash DD slash YYYY
Permanent Health Disability (explain):
Notable Service to the Oregon REALTORS® (Oregon REALTORS® Service required-must be completed) (include year)
Please outline your past and present service to Oregon REALTORS® for a minimum of 3 years; including committees and years served.
Notable Service to your local Board/Association (Must be completed)
Please outline your past and present service on local committees in detail, including committees and years served.
OR
Notable Service to your community
• Volunteering with recognized local community volunteer programs • Serving on City or County Board of Directors/Trustees • List organizations and years served:
Signature
I certify that the above information is accurate and verifiable.
First Last
Date
Date Format: MM slash DD slash YYYY
Current Resume (attach copy)*
Application is considered incomplete if resume is not attached

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