2025 Affiliate Program Application For Membership - Mid-Illinois Realtors® Association

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2025 Affiliate Level
Please select your affiliate level for 2025.

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

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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

Cell # *

Email *

NMLS # (if applicable)

Preferred Phone # *

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

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 #

NMLS #

Preferred Phone #

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

Affiliate #2 Name

Cell Phone #

Direct Office #

NMLS #

Preferred Phone #

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

Affiliate #3 Name

Cell #

Direct Office #

NMLS #

Preferred Phone #

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

Affiliate #4 Name

Cell #

Direct Office #

NMLS #

Preferred Phone #

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

Affiliate #5 Name

Cell #

Direct Office #

Preferred Phone #

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

NMLS #

Additional Affiliate Members

Do you have more than 5 total Affiliates joining?

If Yes, please reach out to Michelle Gudgel, Marketing Director at michelleg@midillinoisrealtors.com.

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 #, EMAIL and NMLS # (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 $111 per quarter

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

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