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.  You may wish to print this page first so that you may have a copy for your records (or print the confirmation page you will see when you submit the form).

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

New Application    Change of Information for Current Member

Name

Business Address
Address (line 2)
Address (line 3)
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?
Life Underwriter  Years
Trust and Banking   Years   Bank Officer Yes  No
Accountancy
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 

Professional Designations Held: Include all that apply. Separate each designation with a comma (e.g. CLU, ChFC, CFP, CPA, JD, 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.

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