IBBA Mid-America Chapter Members

Our chapter members adhere to professional principles to provide a foundation of quality, responsibility, integrity, and honor in all business relationships and transactions.

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Date
Name*
First Last
Title*
Company Name*
Primary Business Function of Company*
In order to join as a Corporate Associate and receive the discounted membership rate, please enter your Corporate Primary member who must be in good standing
Full-time business broker?
- Yes
- No
Other business venture:
Company Address*
Street Address Address Line 2 City State ZIP Code
Home Address
Street Address Address Line 2 City State ZIP Code
Username
Password*
Enter Password Confirm Password
Email*
Enter Email Confirm Email
Please upload your photo*
Accepted file types: jpg, gif, Max. file size: 50 MB.
Photo should be a good quality color photo of you.
Please upload your logo*
Accepted file types: ai, eps, pdf, jpg, jpeg, png, Max. file size: 50 MB.
Logo should be a good quality image. Allowed extensions are: ai, eps, pdf, jpg, jpeg and png.
Office Phone*
FAX Number
Home Phone
Cell Phone*
Website
Facebook Address
Please copy and paste the FaceBook address you use professionally, if any.
LinkedIn Address
Please list the Linked In address you use professionally.
Twitter Address
Please list your professional Twitter handle, if you have one.
Please list where you received, or are currently receiving your Business Brokerage training, also your related experience, including past sales and/or your current listings.
State licenses and/or Professional Accreditations you hold:
Professional Licensing information
State License Number
Please check type of license
- Real Estate Sales Agent
- Real Estate Broker's License
Please describe your company and/or personal areas of specialization:*
Please list memberships in other Professional Associations:
Are you currently a member of the M&A Source?*
How did you hear about the IBBA Mid-America?*
Invited / Referred by*
Other*
Comments
Check here if you would like to be contacted about sponsoring a IBBA Mid-America event/conference.
Check here if you would like to be contacted about joining a IBBA Mid-America committee.
Agreement*
I Agree

1. I have received, read and, if approved for membership, agree to abide by the Code of Professional Responsibility of the Mid-America Business Broker Association and all future amendments thereto.
2. I authorize the membership committee to verify the information herein.
Broker Membership*
Price:
Payment Method*

American Express
Discover
MasterCard
Visa
Maestro
Supported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro
Card Number Expiration Date Security Code Cardholder Name

State	License Number

Broker Chapter Member Application

IBBA Mid-America Chapter Members