ACLCP Congress and Conclave Registration Form

Please complete this registration form for the ACLCP Congress on Life Care Planning Practice Standards and Guidelines and the Advanced Medicare Set-Aside Conclave We thank you for your interest in participating in this program and we look forward to seeing you at Disney.

Name:        

Address 1: 

Address 2: 

City:  State:    Zip: 

Telephone:  Fax: 

 

Conference Fee   

ACLCP Member (Paid 2009 - 2010 Dues)                            $445.00

Non-ACLCP Member                                                             $495.00

Student or Retired:                                                                  $250.00

Please Click the Programs You Plan to Attend:

Congress Workshop                Forensics                      Advanced MSA                      CLCP Review Course

  CLCP Examination                  CLCP - Fellow Written Examination                     MSCC Examination

 

Method of Payment

 Check (Please Make Payable to the ACLCP)

  Credit Card

  Visa              MasterCard            American Express

Card #:

Expiration Date: 

Name on Card: 

Pay on Line:     Please Click on "Association of Certified Life Care Planners" in left column on the Secure Pay opening page to access the Congress

Hotel Reservation - Click "Mickey":   

 

For those persons wishing to pay by check, please remit payment to the following:

13801 Village Mill Drive
Suite 103
Midlothian, Virginia  23114
(804) 378-7273
Contact Person:  Cindy Butler

10 Windsormere Way
Ste. 400
Oviedo, FL. 32765
(407) 949-1822
Contact Person:  Sheri Jasper