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WEPC Membership Application Form

 

Please complete this online membership application form and submit payment of your membership dues as indicated below. When complete, click the submit button to forward your application to WEPC. By submitting your application, you agree not to use the membership roster as a source for solicitation and not to distribute the information regarding members in the directory.

 

The WEPC Board of Directors will review your application at the next WEPC Board meeting and will notify you promptly of its decision. If your application is not approved, your membership dues will be returned to you promptly.

 

You have two options for paying your $175 membership dues. Please indicate your method of payment on the membership application below:

 

 

Your name:
Firm name/Company:
Address:
City:
State:
Zip Code:
Work telephone number (including area code):
Home telephone number (including area code):
Fax (including area code):
E-mail address:

Membership category (select A for Member or B for Associate Member):

A. Member - check as many boxes below as necessary to describe your practice:




  B. Associate Member (a professional who is not in one of the above categories)
Certification - Specify all certifications:
Type of License:
Name as it appears on professional license:
State issuing license:
Disciplinary Action - In checking this box and submitting this form, you certify that no professional accreditation agency or organization with jurisdiction over the conduct of members of the discipline for which you registered with the WEPC has revoked such accreditation.

How many years have you worked in your profession?
Five-word description of your business:

(e.g., certified financial planner, estate planning attorney)

Indicate which committee(s) you want to join or learn more about:







Do you want to participate in the WEPC Speaker's Bureau?



How do you plan on paying your annual membership dues?



Company web site if you want link from WEPC website:
How did you hear about WEPC?