1. Fill out the form 2. Print the form 3. Fax the form Toll Free
to 866 209-5111
STEP 1 - Please
enter your personal information...
Your
Name - EXACTLY as you want it on your
certificate:
Your
Name - As you want it on your name badge:
Company name:
Referred by :
Mailing
address
Street :
City:
State:
Zip Code:
Business
Phone:
Ext:
Fax:
Home Phone:
E-mail Address:
Degree/s Held:
License/s:
Designations or
certifications
Have
you ever been convicted of a Criminal Offence for which you
have not been granted a pardon? *
No
Yes
* A
positive answer to the above does not mean that you
may not apply but be prepared for a delay in your
registration while we investigate your
circumstances.
STEP
2 - Tuition Fees...
The classroom program fee is currently $795.00
The distance learning program is $895.00
(Course pricing is subject to change.)
Both methods include a comprehensive study guide and first-year EPC
membership.
Participants must complete and pass a written examination at an
authorized testing centre before receiving the EPC designation.
STEP 3 - Please
select the Study Option/Location closest to you:
WE MUST BOOK YOUR ROOM FOR YOU IF YOU ARE
STAYING AT THE HOTEL
I do not need a room
Book me a room - My room particulars
-
Smoking
Non
Smoking
2
Double beds
King
Size bed
Note - Room with 2 double beds or 1 king size bed
are the same price!
My exact check - in date is
My exact check - out date is
STEP
4 -
Please select a Payment Plan for your program:
NOTE - A $25.00
Administration Fee is added to the cost for all Students that wish
to take advantage of our Payment Installment Option
Option 1 - Full
Payment
Live Class:
$795.00
Distance Learning Course:
$895.00
Option 2 -
Installment Plan - Only available for live class
Live Class:
$795.00 + $25.00 Administration Fee
÷ 4 equal payments -
Credit card or post dated checks submitted in advance
STEP
5 - Please select your desired method of payment:
For Credit Card
Payment/s - We accept the following cards
Visa
MasterCard Card Number:
---
Expiry Date
Name on card:
For Payment/s made
by Check
Make cheques payable to - American Initiative for Elder Planning
Studies
American Initiative for
Elder Planning Studies
Wiesner Financial Media Group
Suite 200, 7009 South Potomac Street
Centennial, CO
80112
I will Mail my Check/s
Note - Your
designation will be granted when you have successfully passed the
exam and your tuition is paid in full.
$100.00 Corporate
tuition discount from the current posted tuition fee is available
for groups of ten or more attending the same class.
The annual $150.00 Elder Planning Counselor
membership fee for the first year is waived upon payment of
the tuition fee.
Yes
