Application Form

Thank you for your interest in becoming a member of the Estate Planning Council of Hampden County. Please be sure to answer all questions. Please read the organization's objectives before completing this application. To view the council's objectives, copy and paste this link: https://www.estateplan-hc.org/council/aboutAddl

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. There can be only one sponsor per firm listed.

Fill in the information below to apply for Estate Planning Council of Hampden County membership.

Personal Information

First Name

Last Name

Business Name

Email Address

Website

Office Information

Business Address

Business City

Business State & Zipcode

Business Phone

Business Fax

Disciplines

Please indicate what discipline(s) you practice. You may select up to 5 disciplines.

Disciplines

Accountant Attorney Banker Fiduciary Financial Services Insurance Planned Giving

Applicant Questionnaire

Which profession are you affiliated with?

Insurance

Banking/Bank Officer

Accountancy

Elder Planning

Planned Giving

Select Financial Services Provider

Law

If Law, give number of Years and Year admitted to practice and State admitted to

If Select Financial Services Provider, you must provide job title and years in position.

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

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

We require two sponsors. Only one sponsor may be from your own 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 local person of an Estate Planning Council of Hampden County member.

Date of Application

I have read the information on the Home page and About Us pages and understand the nature and objectives of the organization. To view the council's objectives, copy and paste this link: https://www.estateplan-hc.org/council/aboutAddl

Yes

(Signature of applicant, if printing)
Date: Thursday, April 25, 2024

Please contact admin@estateplan-hc.org with questions about council membership.