AIFG Registration

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Prefix (e.g. Dr.)
First Name
Middle Initial
Last Name
Suffix (e.g. Jr.)
Nickname (for name badge)
Date of Birth (mm/dd/yy)
Job Title
Company

Preferred Address
Is the address you are providing...
work
home
Address
Add'l Address
City
US State/Canadian Province:
Zip
Country:

Phone/Email
Daytime Phone
Evening Phone
Fax
Email

Confirmation of existing financial background in the form of education, designation, license, degree, and/or verifiable experience:

College/University City/State Major Degree Year

Highest Level of Education

Your Industry

Years of Industry Experience

Licenses/Registrations/Designations (check all that are current)
CEBS CECA CEPP CEPS
CFA CFP ChFC CLTC
CLTCA CLU CMA CPA
CPCU CSA CSS EA
Health LTCGS LTCIS LTCP
Life NASD NYSE P&C
RHU Series 6/7 RIA
Other

In what state(s) are your licenses/designations currently valid?

Have you ever had a license/designation revoked?
yes
no

Does your current employer provide educational benefits (pay or reimburse you) for this course work?
Yes
No
(percentage:%)

How Did You Hear About AIFG

By submitting this application you certify that all statements in this application are complete and true.

 

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Registered Financial Gerontologist is a trademark of AIFG.