Council Applicant Endorsement Form

New Member Application

Welcome to the Estate Planning Council of Long Island's New Member Application Form! Before applying, review our Council By-Laws to ensure you meet the participation requirements. Your application will be reviewed by our Membership Committee. Please allow up to 30 days for processing and decision.
Your Name*

First NameLast Name
Your Email Address*
example@example.com
Company or Firm*
Business Phone Number*
Please enter a valid phone number.
Personal Phone Number*
Please enter a valid phone number.

Address Information

Please enter your business and home address
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Address*

Street Address

Street Address 2

CityState

Zip Code

Application Details

Please respond to the following questions in detail
Admission is desired in the following group:*

Certified Public Accountant (per Section 3.01 (b)(i) of the By-Laws)Attorney (per Section 3.01 (b)(ii) of the By-Laws)Trust Professional (per Section 3.01 (b)(iii) of the By-Laws)Accredited Financial Planner (per Section 3.01 (b)(iv) of the By-Laws)Other Related Activity (per Section 3.01 (c) of the By-Laws)Associate Member (< 3 years’ experience) (per Section 3.02 (a) of the By-Laws)Associate Member (per Section 3.02 (b) of the By-Laws)Student Member (per Section 3.03 of the By-Laws)
Please list the names of Professional Associations to which you currently belong (e.g. Bar Association, FSP, NAIFA, CFP, FPA, CPA Society, etc.) and how long you have been a member for each of them:*
Please list your Education and Degrees (College, Professional or Graduate School, with dates of graduation):*
Please list the names of firms / corporations with which you have been associated (include dates, positions, etc.):*
Please describe IN DETAIL how you meet the requirements of Section 3.01, Section 3.02, or Section 3.03 of the Council’s By-Laws, including relevant information with regard to your current and past business experience. Additionally, if seeking admission as an Accredited Financial Planner under Section 3.01 (b)(iv), indicate your applicable designation (i.e. CLU, ChFC or CFP).*
Please attach any additional pages or information as needed.

Please note: File upload is optional.
Cancelof

Endorsements

A written endorsement is required of TWO (2) MEMBERS IN GOOD STANDING who personally know you. Please enter the full names of the TWO (2) members who will be endorsing your admittance to the Council. Please enter the contact information of your endorsers.
Endorser 1 Name*

First NameLast Name
Endorser 1 Email Address*
example@example.com
Endorser 2 Name*

First NameLast Name
Endorser 2 Email Address*
example@example.com

Signature

I am submitting this Application for membership subject to the By-Laws and procedures of Estate Planning Council of Long Island, Inc., which provide for a review of my experience, qualifications, education, professional affiliations, and other pertinent factors, initially by the Membership Committee and then by the Board of Directors of the Council. I am aware that the non-acceptance of my Application will not reflect adversely on me and I expressly release the Council, members of the Membership Committee, and Officers and Directors of any claim for damages of any kind and nature resulting from the non-acceptance of my Application. Furthermore, I acknowledge that the consideration of my Application is conditioned on the foregoing truthful representations made by me.
Please verify that you are human*
Signature*

Clear
Reminders: By submitting this form, you agree that the information provided is accurate and truthful to the best of your knowledge. Please provide relevant and accurate information to support the cause.
Should be Empty:

New Member Application

Address Information

Application Details

Endorsements

Signature