WEPC Membership Information Update Form

Please be sure to let us know when any of your contact or professional information has changed. Please complete your name and only the information that has changed.

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)
Certification - Specify all certifications:	(e.g., CLU, ChFC, MBA, JD, CPA, any other, or "none")
Five-word description of your business:	(e.g., certified financial planner, estate planning attorney)
Do you want to participate in the WEPC Speaker's Bureau?	Yes No
Company web site if you want link from WEPC website: