Elder Planning Counselor Program - Segment Registration
STEP 1 - Please enter your personal information:
Your Name - EXACTLY as you want it on your certificate:
Company name:
Referred by : Select one please LIMRA ADVOCIS My Company An Associate E mail Fax Other
Mailing address:
Street:
City: Province: BC AB SK MB ON QC NB PE NS NL YT Postal code:
Business Phone: Ext: Fax:
Home or Cell Phone: E-mail Address:
Personal Information:
University Degree/s Held:
License/s:
Designations or certifications held:
* Have you ever been convicted of a Criminal Offence for which you have not been granted a pardon? NO YES
* A positive answer to the above does not mean that you may not apply but be prepared for a delay in your registration while we investigate your circumstances.
Tuition Fees
Your first-year annual EPC membership fee is waived upon successful completion of Module 4. After completing segment 4 students must complete and pass a written examination at an authorized testing centre before receiving their EPC designation.
Please select the module you wish to do at this time SELECT ONE Complete Program Module 1 Module 2 Module 3 Module 4
Payment
Complete Program - (consists of all 4 modules) $1,095 + Applicable tax for your Province
Module 1 - $295.00 + Applicable tax for your Province
Module 2 - $295.00 + Applicable tax for your Province
Module 3 - $295.00 + Applicable tax for your Province
Module 4 - $295.00 + Applicable tax for your Province
Please select your desired method of payment:
For Credit Card Payment/s - We accept the following cards
Credit card information Card Type Visa Mastercard Card Number: --- Expiry Date 01 02 03 04 05 06 07 08 09 10 11 12 20 12 13 14 15 16 17
I will Mail my Cheque I will ICS my Cheque
If you are paying by Cheque - Your material will be shipped immediately upon receipt of your cheque Make cheques payable to - CIEPS
Mail or ICS cheque/s to:
Pro-Seminars Suite 203, 4438 Ontario Street Beamsville, ON L0R 1B5
Note - Your designation will be granted when you have successfully passed the final exam.
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