2026 MIRA Affiliate Program Application

Application for participation in the MIRA Affiliate Program from 2026. This is for MIRA affiliate businesses only. 

Fields marked with an * are required.

Please verify that you have checked the “I'm not a robot” checkbox.

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2026 Affiliate Level
Please select your affiliate level for 2026.

Platinum - $3,356
Gold - $2,021
Silver - $1,045
Basic - $360
Company Information
Please complete in full for your member directory listing.

Do you offer Notary services at your business?

Yes
No

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Primary Affiliate Member
Please complete in full for your member directory listing. This individual will be MIRA's main point of contact for all membership decisions.

First and Last Name of Primary Contact

What is your preferred phone number to appear on the online member directory?

Please include all that apply.

Affilate Members
Please complete in full for your member directory listing. Platinum Level - (1) Primary and (5) Additional Affiliates; Gold Level - (1) Primary and (4) Additional Affiliates; Silver Level - (1) Primary and (2) Additional Affiliates; Basic Level - (1) Primary Only (Additional Affiliates available at $50 per person)

What is your preferred phone number to appear on the online member directory?

Please list all that apply.

What is your preferred phone number to appear on the online member directory?

Please list all that apply.

What is your preferred phone number to appear on the online member directory?

Please list all that apply.

What is your preferred phone number to appear on the online member directory?

Please list all that apply.

What is your preferred phone number to appear on the online member directory?

Please list all that apply.

Additional Affiliate Members

If yes, please complete the following questions and you will be billed accordingly.

A new invoice that reflects these additional affiliates will be sent to you via email.

Please list the NAME, CELL #, DIRECT OFFICE #, NMLS # (if applicable) and OTHER LANGUAGES SPOKEN (if applicable) for each additional affiliate.

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Add-on Services
Please check all that apply and you will be billed accordingly. For further questions about pricing, please contact Michelle Gudgel, Marketing Director at michelleg@midillinoisrealtors.com.

Only available for affiliate members that need eKey access. Billing is prorated and renewed in March of the following year. Please inquire for pricing.

Billed per quarter. Please inquire for pricing.

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A la Carte Opportunities

Please select all that apply and you will be invoiced accordingly.

$50 - Each Additional Affiliate (not already included in your level)
$500 - MIRA Happy Hour/Networking Event Sponsor
$200 - Education Class/Empower Hour Sponsor
$125 - Golf Hole Sponsor
$500 - Golf Lunch Sponsor (2 available)
$1000 - Golf Drink Cart Sponsor (2 available)
$700 - Golf Morning Cocktail Sponsor
$400 - Live Music Sponsor
$600 - Photobooth Sponsor (2 available)