Membership Application/Change of Information

If you would like to become a member of the Estate Planning Council of Hampden County, Inc., or if your information has changed, please fill in this form and press the Submit button. Please be sure that an e-mail containing your responses has been generated, and please allow your outbox to empty. You may wish to keep a copy for your records.

If you have not read the organization's objectives, please click here. Read Objectives 

New Application    Change of Information for Current Member

Name

Firm Name

Address (line 1)
Address (line 2)
City    State
Zip Code
Telephone   FAX
e-mail

Home Address
City   State
Zip Code
Telephone

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Which profession(s) are you affiliated with and for how long?
Insurance  Years
Banking   Years   Bank Officer Yes  No
Accountancy Elder Planning Planned Giving
Law  Years   Year admitted to practice   State admitted to
Select Financial Services Provider   Note:  If you are a select financial services provider, job title and years in position must be provided.
Job Title   Years in Position 

Describe briefly how you are actively involved in the estate planning process. Include how long you have been doing this work.

Estate Planning Experience [Drag the lower right corner of the box to the right, to expand it.]

Professional Designations Held: Include all that apply. Separate each designation with a comma (e.g. CLU, ChFC, CFP, CPA, JD, Esq., None)


Recommendations:  

Two recommendations are required. One of the recommending parties must be from the same profession as the applicant, and the other recommendation must be from a current member of The Estate Planning Council of Hampden County, Inc.(only one sponsor per firm)

Please indicate the name, profession, business address, telephone number, and e-mail address of a local person in your profession.


Please indicate the name, profession, business address, telephone number, and e-mail address of a Council member.

Date of application
I have read the information on the home page and understand the nature and objectives of the organization. Yes

Thank you for your application/change of information.