Form 3102 (Revised 03/15) Submit to: Secretary of State Registrations Unit P.O. Box 13550 Austin, TX 78711-3550 512 475-0775 FAX: 512 475-2815 Filing Fee: $50.00 This space reserved for office use. Membership Camping Resort Sales Person or Contract-Broker Registration Application I am applying for: (please circle one) SALESPERSON 1. 2. CONTRACT-BROKER Name of Applicant:__________________________________________________________________ Residence Address:_________________________________________________________________ ____________________________________________________________________________________ 3. 4. Telephone Numbers: Home ( )__________________ Business ( )___________________ Business Address:____________________________________________________________________ ____________________________________________________________________________________ 5. 6. Name of Employer: (if applicable)_____________________________________________________ Address of Employer:(if applicable)___________________________________________________ _____________________________________________________________________________________ 7. Have you ever been convicted of a felony or a misdemeanor involving moral turpitude? _________ Yes _________No 8. If you answered yes to Question 7, describe the nature of the crime, when and where it was committed, and the disposition of the conviction. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 9. Have you been refused a real estate broker's or salesperson's license, or any other occupation license in ________Yes ________ No this or a American LegalNet, Inc. www.FormsWorkFlow.com 10. If you answered yes to Question 9, explain fully the circumstances of the refusal. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 11. Has your license as a real estate broker or salesperson in this or any other state ever been revoked or suspended? _______ Yes ________ No 12. If you answered yes to Question 11, explain fully the circumstances of the denial or suspension. ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I certify (or declare), under penalty of perjury, that I have read the foregoing registration and that all the answers are true and correct. Further, I understand and agree that any misstatements of a material fact in this application may result in suspension or revocation of my registration with the State of Texas. ____________________________________________ Signature of Applicant ************************************************************ RETURN THIS APPLICATION WITH THE $50.00 FILING FEE TO: SECRETARY OF STATE REGISTRATIONS UNIT P. O. BOX 13550 AUSTIN, TX 78711-3550 FOR DELIVERY: JAMES EARL RUDDER OFFICE BUILDING 1019 BRAZOS AUSTIN, TX 78701 American LegalNet, Inc. www.FormsWorkFlow.com