F400Series - Virginia REALTORS®

Experience Verification Form

Please print this form and have your broker complete and sign. Then, upload the completed form in the space indicated below.

About You

Name*

First Last

Your name as you would like it to appear on your certificate*

NRDS ID*

Your Email Address*

Your Local Association*

Name of Your Firm*

Firm Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address for Certificate (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone

Your Professional Photograph*

Accepted file types: jpg, gif, png, Max. file size: 100 MB.

We would like to recognize graduates of the PM Certified on our website and at our PM-related events.

Your Principal Broker

Please complete this section even if you are the broker.

Name of Your Principal Broker*

First Last

The name of the principal or supervising/managing broker for your office.

Principal or Supervising/Managing Broker Email Address*

Experience Verification Form*

Max. file size: 100 MB.

Please add COMPLETED verification form here.

Consent

Consent*

I agree to pay the certification fee.

Payment of the designation fee in the amount of $125.00 will be billed and payment must be made online. You will be sent an email from Virginia, REALTORS® (membership@virginiarealtors.org) with information on how to pay online.

To retain the rights to use the PM Certified credentials, you must maintain membership status with the Virginia REALTORS® and attend an annual VAR-sponsored Virginia Residential Landlord Tenant Act (VRLTA) update class.

I verify that all information given in this application is true and complete to the best of my knowledge.

Today's Date*

Untitled

Experience Verification Form

Please print this form and have your broker complete and sign. Then, upload the completed form in the space indicated below.

About You

Your Principal Broker

Consent

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