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2005 Membership Application

Nebraska Association of Mortgage Brokers, Inc.

Note: With this membership application, you are applying for membership in the state Association of Mortgage Brokers (NEAMB) and the National Association of Mortgage Brokers (NAMB).

If paying by credit card, please complete all sections. If paying by check, please complete sections I and II and mail your application with check to: NAMB, 8201 Greensboro Dr. Suite 300, McLean, VA 22102, Attn: Miranda Turner

I. Personal Data  
Full Name: Mr. Mrs. Ms.
First Name:*
Middle Initial:
Last Name:*
Suffix:
Preferred/Badge Name (if applicable):
Job Title:*
Company:*
Street Address:*
City:*
State:*
Zip:*
Phone:*

Fax:*
E-mail:*
I would like to serve on a NAMB or NEAMB Committee

-NAMB sends "members only" materials and News from NAMB during off-peak hours via fax or e-mail. Under no circumstances does NAMB release your e-mail address to outside parties.

II. References  
Name:
Phone:
If this individual personally referred you to our organization, check here. Individuals who recruit new members will be recognized.

Membership Policies
NEAMB and NAMB are Individual Member Societies; there are no corporate memberships. Your membership transfers with you if you change employers. All memberships expire 12/31/2005. A renewal form will be sent to you in late 2005. If your contact information changes, please call NAMB (703) 610-9009 and NEAMB (402) 964-9600 David Novak.

Membership Categories and Fees (please check one):*
Professional Individual: $195.00
Any individual licensed as or acting as a mortgage broker.
Associate Individual: $75.00
Any individual employed by a Professional Individual member. Associate membership is not open to individuals qualified to be Professional Individual members.
Affiliate Individual: $150.00
Any individual whose business is other than that of a mortgage broker. Affiliate members must declare one of the following subtypes below, based on your employer's business type:
  Lender Individual Other Individual

Business Data
(Check only the primary loan type(s) that apply to your business.)

Conforming
B-C-D
FHA
VA
Jumbo
Commercial

License #:
State:
Type:
Exp Date:

Membership Agreement
(You must agree to the following in order to continue)
I pledge to abide by the requirements of the NEAMB and NAMB Code of Ethics and the NAMB Best Lending Practices guidelines. I also pledge to support the state and national bylaws and board policies, as they are now and as they may be amended.

Signify your agreement by typing "I Agree" in the following field. *

III. Payment Information  
Total:*
Please Charge My:*
Name on Credit Card:*
Card Number:*
Expiration Date:*

By clicking the submit button below, you are authorizing NAMB to process your membership.

We estimate that 58% of your 2005 NAMB dues are not deductible. Federal Law prohibits the deduction from your taxes that portion of member dues allocated to federal lobbying activities.