Greater Boca Raton Estate Planning Council by s60fx45Y


									                     Greater Boca Raton Estate Planning Council
                      Membership Renewal: Fiscal Year – 2011-2012

I. Please fill out your proposed directory listing/mailing address below.

   Membership Category (choose one): A. Trust Officer, B. Attorney, C. CPA, Chartered Life Underwriter,
   Chartered Financial Consultant or Certified Financial Planner, or D. Full-time Planned Giving
   Professional employed by or consulting with 501(c)(3) organization(s).

                                         City, State Zip
                                         Telephone Number - Telephone
                                         Fax Number - Fax
                                         E-Mail Address

II. Your proposed badge appears below.


III. Your e-mail address (if you want it listed in the Membership Directory):

IV. Home Address/Phone:______________________________________________________________
    (Not for Publication)________________________________________________________________
V. Direct all correspondence to: (Circle One)            BUSINESS               HOME

VI. Regarding my membership category, I certify the following (check only one):
    a. I remain in the same membership category as the previous year:_____.
    b. I have moved from my previous category to my new category:_______.
    My former category was _____________ and my new category is _______________

    NOTE: Any member moving from one category to another must meet the requirements of the new category in
    order to retain membership, including appropriate designations and licenses for a minimum of 12 months.

        __________________                       _____________________________________________
        Date                                            Signature of Member

        Return to:      Sylvia Tausk                     Membership Dues of $250 must be received
                        GBREPC                           with completed renewal application by
                        8658 Via Reale, #2               September 29, 2012 (Make check payable to GBREPC)
                        Boca Raton, Florida 33496

If you wish to have your name inserted in the Membership Directory, it is imperative that your Membership
Renewals be received no later than September29, 2012. Any renewal form received after October 1st will be
considered as a new application. Complete business address, phone and fax number will be printed in the directory
unless you enclose different instructions.

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