"*" indicates required fields 1Personal Information2About Your Brokerage Name* First Last Email* Phone Number*Mailing State*Mailing State*ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYRole*Role (Select One)*Broker OwnerLoan OriginatorLoan Originator AssistantBranch ManagerSales ManagerProcessorContract ProcessorAdminRecruiterMarketingUpper ManagementOtherOperations ManagerDo you originate loans?* Yes No Individual NMLS*Please enter a number from 0 to 9999999999999.State Licenses*ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDesired Membership Level*Desired Membership Level (Select One)*Premium Guest (90-Day Trial)Premium – $19.99/mo. ($199/year)Elite – $69.99/mo. ($699/year)VIP – $199.99/mo ($1,999/year) Brokerage Name* DBA or Brand Name You Conduct Business Under Please leave blank if not applicableBrokerage NMLS*Please enter a number from 0 to 9999999999999.Brokerage Phone*Headquarters State*Headquarters State (Select One)*ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYWhat states is your brokerage licensed in?*ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYHow did you hear about AIME?*Click To SelectSuccess TrackAIME MemberBrokers Are Better Facebook GroupFacebookGoogleLinkedInAccount ExecutiveIndustry Publication/NewsletterOtherHiddenAccount Type HiddenLead Source HiddenLead Source Form **By submitting this form, you certify that you are a mortgage broker or loan officer/originator with a valid NMLS number and operating or affiliated with a company or entity that does not underwrite its own loans; OR you operate as a processor for independent brokers or loan originators/officers who have a valid NMLS number and who do not underwrite their own loans. You also are opting in for marketing, and industry update communication Please contact info@AIMEgroup.com or 215-720-1794 (AIME) with any questions.