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certificate, registration, or membership denied, suspended, revoked, or restricted, or have you had an application withdrawn for cause by any regulatory body, or any professional organization or association of which you are a member?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.

Tuition Fees: Until June 1, 2024, Tuition Fees for all methods of attaining your EPC Designation will be $895 + tax.
The live classroom program tuition fee is $895.00 + TAX
The distance learning & Live Stream webinar program tuition fee is $895 + TAX
All methods include the 4 Module EPC Desk References, a Comprehensive EPC Student Workbook & the EPC Designation Program Registration Booklet.
All students must complete and pass a written EPC Qualification examination at an authorized testing centre, or with a supplied Proctor present before receiving the EPC designation. This examination will either be proctored in person, or via Zoom.
Your first-year EPC membership fee is waived with the initial cost of tuition. Your next membership fee is 1-year after you graduate.

Please select the EPC Registration Option That Suits You:

Please select a Payment Plan for your program choice:

Option 1 - Full Payment

	Live Exam Preparation in person Class $895.00 + TAX
	Live Exam Preparation by Live Stream / Webinar Option $895.00 + TAX
	Distance learning $895 + TAX
	EPC exam rewrite $150 + TAX
	EPC Qualification Requirements met from another Elder Designation (e.g. CPCA) or Elder program taken $695.00* + 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. *This is a limited time pricing offer

Option 2 - Instalment Plan Option Available only for the Live class option. A $25.00 Administration Fee is added to the tuition cost for all Students that 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:
$895.00 + $25.00 Administration Fee + TAX 4 equal payments

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

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