Dynamic Funds Exam Registration

dynamicfunds

This form to be used only when:

1. You have now successfully completed the 4 EPC Designation modules available on the Dynamic Funds advisor site and you want to write the Proctored Elder Planning Counselor Designation Qualification Examination. This exam consists of 125 multiple choice questions. You need to achieve a 70% pass mark to successfully achieve your EPC Designation. The fee for the EPC Qualification examination is $175 plus HST / GST for your Province of residence.

2. You need to schedule an EPC Qualification examination rewrite. The fee for this is $150 plus HST / GST for your Province of residence.

3. You want to register for an EPC Live Exam Preparation Class either in person or by Live Webcast. The special reduced Dynamic tuition to attend the “LIVE” In-Person 3.5-day OR the “LIVE” Webcast (streamed from a LIVE In-Person class as avaialble) 3-day EPC Exam Preparation class is $895 plus HST/GST. The normal tuition for this option is $1295 plus HST/GST for your Province of residence.

Please enter your name as you want it to appear on any EPC Certificates

First Name Last Name

CIPR # (if you have one)

Company

Street:

City: Province: Postal Code:

Business Phone: Ext:

Fax: Home Phone: Cell Phone:

E-mail Address:

Degree(s) Held:

Designations or Certifications:

License(s):

LEGAL AND DISCLOSURE REQUIREMENTS

Have you ever been convicted of a Criminal Offence for which you have not been granted a pardon?
NO YES

Have you ever been disciplined or had any restrictions placed on any professional license, permit, certificate, registration, or membership denied, suspended, revoked, or restricted, or have you had an application withdrawn for cause by any regulatory body, or any professional organization or association of which you are a member?
NO YES

Have you ever been censured, fined, or reprimanded by any regulatory body, professional organization, or association of which you are a member?
NO YES

* A positive answer to either of the above does not mean that you may not apply but be prepared for a delay in your registration while we investigate your circumstances.

I will abide by the CIEPS Member Code of Professional Conduct.
NO YES

Questions? Type anything you have a question about here and we will get back to you.

Please let us know if you are registering for an EPC Live class or the EPC Qualification examination.

I am registering for:

Referred by:

Note - Your designation will be granted when you have successfully passed the exam and your exam fee is paid in full.

You have 3 options to pay:

1. By Credit Card

Credit Card Information

Card Number Expiry Date

PLEASE LEAVE A SPACE BETWEEN THE CARD NUMBERS EXAMPLE - 5555 4444 3333 0000

CVV (3 Digit Code on the back of your Credit Card)

2. By Interact Email Transder to - payments@cieps.com You do not require a password for this option.

3. By cheque payable to - CIEPS

Mail cheque to:

Canadian Initiative for Elder Planning Studies

4438 Ontario Street, Suite 203

Beamsville, ON L3J 0A4

Type 1234 in the box -----> click Submit:

Canadian Initiative for Elder Planning Studies Inc.
203-4438 Ontario Street
Beamsville, ON L3J 0A4

Toll Free Phone 866 833-8606 Toll Free Fax 866 209-5111

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