2026 MIRA Affiliate Program Application - MID-ILLINOIS REALTORS® ASSOCIA

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2026 Affiliate Level
Please select your affiliate level for 2026.

Application Sumitted By:

Affiliate Level *

Platinum - $3,356

Gold - $2,021

Silver - $1,045

Basic - $360

Company Information
Please complete in full for your member directory listing.

Company Name *

Street Address *

City, State, Zip *

Office Phone # *

Website URL

Notary

Do you offer Notary services at your business?

Yes

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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.

Primary Affiliate Name *

First and Last Name of Primary Contact

Cell # *

Email *

NMLS # (if applicable)

Preferred Phone # *

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

Other languages Spoken

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)

Affiliate #1 Name

Cell #

Direct Office #

Preferred Phone #

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

NMLS # (For Affiliates)

Other Languages Spoken

Please list all that apply.

Affiliate #2 Name

Cell Phone #

Direct Office #

Preferred Phone #

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

NMLS # (For Affiliates)

Other Languages Spoken

Please list all that apply.

Affiliate #3 Name

Cell #

Direct Office #

Preferred Phone #

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

NMLS # (For Affiliates)

Other Languages Spoken

Please list all that apply.

Affiliate #4 Name

Preferred Phone #

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

NMLS # (For Affiliates)

Other Languages Spoken

Please list all that apply.

Affiliate #5 Name

Preferred Phone #

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

NMLS # (For Affiliates)

Other Languages Spoken

Please list all that apply.

Additional Affiliate Members

Do you have more Affiliate employees joining than are included in your package?

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

If yes, how many?

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

Additional Affilaite Contact Information

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.

Supra eKey Acess

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

ShowingTime Access

Billed per quarter. Please inquire for pricing.

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A la Carte Opportunities

What a la carte opportunities would you like to add.

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)

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

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