WEPC Membership Application Form

Please complete this online membership application form. When complete, click the submit button for forward you application to WEPC. By submitting your application, you agree to not use the membership roster as a source for solicitation and to not distribute the information regarding members in the directory.

The WEPC Board of Directors will review your application prior to the next WEPC meeting and will notify you promptly of its decision. Upon approval of your application, please made payment of your membership dues ($125 for applications made in May through December and $62.50 for applications made in January through April):

To pay via credit card, visit our website membership page at www.wepc.net/membership.html and click on the appropriate payment button.
To pay via check, send check made payable to WEPC to: Heidi Mourning; GHP Horwath, PC; 1670 Broadway, Suite #3000; Denver, CO 80202. Please specify your name on the check if the check is in your company’s name.

Your name:
Firm name/Company:
Address:
City:
State:
Zip Code:
Work telephone number (including area code):
Home telephone number (including area code):
Fax (including area code):
E-mail address:
Membership category	(select A or B):
	A. Member - check as many boxes below as necessary to describe your practice: Accredited Financial Services Professional (CLU, ChFC, CFP, MSFS, LUTCF, CTFA, MBA) Attorney (licensed to practice in Colorado) CPA (licensed to practice in Colorado) Trust officer (employed by a trust company or a bank trust department in Colorado)
Name as it appears on professional license:
State issuing license:
	B. Associate Member
Certification - Specify all certifications:	(e.g., CLU, ChFC, MBA, JD, CPA, any other, or "none")
Disciplinary Action - In checking this box and submitting this form, you certify that no professional accreditation agency or organization with jurisdiction over the conduct of members of the discipline for which you registered with the WEPC has revoked such accreditation.
How many years have you worked in your profession?
Five-word description of your business:	(e.g., certified financial planner, estate planning attorney)
Indicate which committee(s) you would like to join:	Membership Programs PR/Community Outreach Hospitality Newsletter
Do you want to participate in the WEPC Speaker's Bureau?	Yes No
Company web site if you want link from WEPC website:
How did you hear about WEPC?