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). Name Company Address City, State Zip Telephone Number - Telephone Fax Number - Fax E-Mail Address II. Your proposed badge appears below. Name Category Company 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 Home Address/Phone:______________________________________________________________ (Not for Publication)________________________________________________________________ V. Direct all correspondence to: (Circle One) BUSINESS HOME VI.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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