March 7, 2024 Breakfast Sponsor

Application Form

GREATER MIDDLESEX/SOMERSET
ESTATE PLANNING COUNCIL
2023-2024
MEMBERSHIP APPLICATION
( ) Individual $375 ( ) Corporate $700
(includes meal charges for 6 programs, Continuing Education credits (same as individual member benefits for
up to three (3) attendees from corporate member)
(   ) New (   ) Renewal
Name and Title: ___________________________________________________________
Organization: _____________________________________________________________
Business Address: _________________________________________________________
________________________________________________________________________
Telephone: _______________________________________________________________
Email address: _____________________________________________________________
(Please include full names and email addresses for all corporate members on a separate sheet– notices are sent via email)
Please attach your business card to this application.
Profession: (please check one). Please provide your ID # for appropriate C/E credits
_____ Accountant CPE # ______          _____ Trust Advisor
_____ Attorney ID# ___________         _____ Financial Advisor CFP# ________
_____ Insurance Agent ________         Other: ______________________
Please make checks payable to: “Greater Middlesex/Somerset Estate Planning Council" and send to:
Greater Middlesex/Somerset Estate Planning Council
c/o Jayne C. Kredatus, CTFA
16 Stapleton Court
Bridgewater, NJ 08807
Phone: 908-963-5463
Email: jayne.kredatus@gmail.com