Secure Registration Form

SECURE ENROLMENT FORM

Please enter your personal information:

Upon successful completion of the EPC Designation program requirements, you will receive the official, suitable for framing Certificate acknowledging your new qualifications.

Your Name - EXACTLY as you want it printed on your official certificate:

First Name Last Name

CIPR #

Referred by :

Your Name - As you want it on your name badge if you are attending the live class:

First Name Last Name

Company

PERSONAL INFORMATION

Mailing address:

Street:

City:

Province: Postal Code:

Business Phone: Ext:

Fax: Home Phone: Cell Phone:

E-mail Address:

Degree/s, Post Secondary Certificate/s Held:

Designations or Certificates:

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certificate, registration, or membership denied, suspended, revoked, or restricted, or have you had an application withdrawn for cause by any regulatory body, or any professional organization or association of which you are a member?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 that you have a question about here and we will get back to you.

Please select the EPC Registration Option That Suits You:

Please select a Payment Plan for your program choice:

Please select your EPC program choice:

Option 1	Distance learning - $995 + TAX * Please see note below
Option 2	Live Exam Preparation in person Class - $1095+ TAX
Option 3	Live Exam Preparation by Live Stream / Webinar Option - $1095+ TAX
Option 4	EPC Qualification Requirements met from another Elder Designation (e.g. CPCA) or another Elder program taken - $595.00 + TAX. By selecting this option, I confirm that I am a member in good standing from another Elder Designation (e. g. CPCA) or elder program that I have completed.
Option 5	EPC Designation Challenge Examination - $695 + TAX
Option 6	EPC exam rewrite $150 + TAX

* Note for above Distance Learning Option - If you registered for the Distance Learning option but decide you want to attend a LIVE Webcast Exam Preparation Class (as availability allows), to further prepare for your final EPC Qualification examination, or to update your EPC "aging" knowledge, there will be an additional $200 + tax fee if you have the current 12th Edition EPC study materials. If not, the registration fee is $495 + taxes and we will send them to you in PDF format.

INSTALLMENT PLAN OPTION AVAILABLE (based on regular tuition pricing) for the Live In Person or Live Stream / Webinar class option. A $100.00 Administration Fee is added to the tuition cost for all students who wish to take advantage of our Instalment Payment Option. Please note that some of our EPC delivery partners may have a different installment plan or administration fee. They will advise you if that is the case.

Live Class: $1295.00 + $100.00 Administration Fee + TAX paid in 4 equal payments - A credit card on file for this option is necessary.

Please note – If you elect the installment plan option, you will not receive your results or any CE certificates until payment is made in full.

Please select your desired method of payment:

We accept Visa or MasterCard only for Credit Card Payment

Alternatively, we accept E-transfers sent to – payments@cieps.com. Password is not required.

Payment Type

* Card Number Expiry Date

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

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

Name on card:

Please note: All charges are completed manually.

For Payments made by Cheque, please make cheques payable to - CIEPS

Mail cheque/s to:

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

PLEASE NOTE - If you are sending a cheque using ICS please do not require a signature for delivery!

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

Type 1234 in the box to the right then click Submit Form:

Canadian Initiative for Elder Planning Studies Inc.
203-4438 Ontario Street

Beamsville, ON L3J 0A4

Toll Free Phone 855 882-3427 Toll Free Fax 866 209-5111

"EPC designation, EPC, canadian elder benefits, Elder Planning Counselor, Distance Learning, Correspondence Course, CE Credits, CSA, Certified Senior Advisor, estate planning, end of life planning, senior social issues, elders, caregiving, caregiver, chronic illnesses, retirement benefits, government benefits, OAS, CPP, lifestyle, dementia, dymentia, alzheimer's, alzheimers, medicare, bereavement, snowbirds, funeral planning, end of life issues, designation program, training, certification class, correspondence course, online study, seniors, 50 plus, textbook, correspondence, CIEPS, Canadian Initiative for Elder Planning Studies, competitive edge, advisors, older people, elder marketing, old, boomers, marketing strength, education, elder studies, institute, insurance financial planning, health, long term care, gerontology, lifestyle, counselling, retirement, training for professionals"