Application Form

GREATER MIDDLESEX/SOMERSET
ESTATE PLANNING COUNCIL
2021-2022
MEMBERSHIP APPLICATION
( ) Individual $350 ( ) Corporate $675
(includes meal charges for 6 programs, Continuing Education credits (same as individual member benefits for
and one wine or beer during cocktail hour) up to three (3) attendees from corporate member)
( ) New ( ) Renewal
Name and Title: _____________________________________________________________
Organization: _____________________________________________________________
Business Address: _____________________________________________________________
_____________________________________________________________
Telephone: _____________________________________________________________
Fax #: _____________________________________________________________
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