EPC Elder Planning Counselor

SECURE MEMBERSHIP RENEWAL

Your requirements for renewing your EPC Designation

If you are a licensed professional and you require CE credits to maintain your license and your licence is current we will accept that you have met the CE requirement to maintain your designation.

If you are in a profession that does not require you to maintain Continuing Education credits you will not require formal Continuing Education confirmation to renew your EPC membership.

PLEASE DO NOT USE ALL CAPITAL LETTERS

STEP 1 - Please enter your personal information 

Your Name:

Company:

Mailing address:

City:

Province:

Postal code:

   Is this a "NEW" address?   Yes    No 

Business  Phone:

 

Ext: 

Home Phone:

     Cell Phone: 

Fax:

E-mail Address:

Do you have any "NEW" Designations or certifications that we do not know about?     Yes    No 

If Yes - what are they?    

 

SINCE YOUR LAST RENEWAL

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

Have you been disciplined or had any restrictions placed on any professional licence that you hold by any Regulatory Body or Association?   NO    YES

STEP 2 - Education Certification * Only applies to an individual who is licensed

By initializing below I hereby certify that I have attained 30 continuing education credits this renewal period.

Please type your initials here if applicable

PLEASE NOTE - At the time of renewal you will not be required to submit any CE supporting documentation. CIEPS relies on the accuracy of the EPC Professional's self-assessment of their CE activities. Therefore, you will ONLY be required to submit your CE supporting documentation if you are selected in the random audit.

* Your requirements for renewing your EPC Designation
If you are a licensed professional and you require CE credits to maintain your license and your licence is current we will accept that you have met the CE requirement to maintain your designation.
If you are in a profession that does not require you to maintain Continuing Education credits you will not require formal Continuing Education confirmation to renew your EPC membership.

STEP 3 - Membership Renewal Fees
Option 1 - Full Payment
Annual Renewal - Credit Card or Cheque
$150.00 + Applicable TAX for your Province of Residence

Option 2 - Monthly Installment Plan - Credit Card Payments Only Please!
Monthly Installments
12.50 + $1.50 Service Charge & Applicable TAX for your Province of Residence

Option 3 - Retired Member
Annual Renewal
$25.00 + Applicable TAX for your Province of Residence

I will mail a cheque

We accept Visa and Mastercard

Credit card information 

* Card Number            Expiry Date    20  

CVV2#    (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:

 

For Annual Payments made by Cheque 
Make cheques payable to - Canadian Initiative for Elder Planning Studies

Mail or ICS cheques to:

Canadian Initiative for Elder Planning Studies
4438 Ontario Street, Suite 203
Beamsville, ON  L0R 1B5

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

 

 

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

Beamsville, ON L0R1B5

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