Local Political Coordinator Application Form

Thank you for your interest in the Local Political Coordinator Program. After your application is submitted, it will be reviewed by RASEM’s Government Relations Committee at its next scheduled meeting so long as the application is received within 72 hours of the meeting. Following the review, a member of our staff will contact you regarding the status of your application.

Fields marked with an * are required.

Full Name

Company Name

Home Address

Phone Number

Number of Years as a REALTOR®

Name of Legislator and Position They Hold

Name of City or Town of the Above Legislator

Are you a constituent or resident?

Relevant Relationship with Legislator

An LPC's most valuable contribution to RASEM is the relationship they have with their legislator. Please explain your relationship with your legislator.

Additional Information

Please share any other information, including positions that you have held (appointed or otherwise), that should be considered in your application.

Signature *

Acknowledgement of Terms

By signing this form, I confirm that the information provided is accurate to the best of my knowledge and agree to follow the Association's established talking points and responsibilities.

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