NCLP National Center on Life Planning
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Registration Form

Background Information

           Congratulations on your decision to attend the NCLP Program, "Special Needs Planning for Professional Advisors. We created this course to educate and inspire you to dedicate a part or all of your professional career to the special needs community. Our responsibility is to provide the best program possible. In order to do this, we ask that you complete the following form.  

           Accommodations are based on Double Occupancy. If you have someone you wish to room with, please provide us with their name. You may request a private room at additional cost.       

1. Contact and Statistical Information
A. Name
B. Business Address
C. Business Phone
D. Business Fax
E. Email Address
F. Home Address
G. Home Phone
H. Cell Phone
I. Date of Birth
J. Sex
K. Marital Status
2. Background Information  
A. Job Title
B. Professional designations
C. Years in Practice
D. Employer
3. What date do you wish to attend? January 2007 or February 2007?
4. What motivated you to take this course?
5. Are you currently involved in any way with the Special Needs Community?
6. Do you have a loved one with special needs?
7. What are your expectations of this course?
8. Do you have special areas of interest?
9. In what way do you plan to use the knowledge you gain as a planner?
10. Would you be interested in utilizing seminars in your marketing?
11. What geographical areas do you offer your services? Local, State, National?
12. Would you be interested in assisting other professionals as a consultant both in your community and through NCLP to future graduates?
13. What knowledge and/or personal experiences do you have that you feel would be of benefit to our students?
14. Is your compensation fee based, commissioned, or both?
15. Would you like the availability of a support system of professionals (including our faculty) to assist you in your case work and studies?
16. Do you require any special accommodations with your lodging or meeting room?
17. Please add any additional comments or questions.

Thank you for providing this information. It will help us greatly. On behalf of our faculty and staff, we look forward to seeing you at the school.

Register online by completing the following form. Your tuition is payable with a credit card through our secure shopping cart. You may also print and fax your enrollment form to 480-556-0714, or mail it with your check or money order. Click this link to download the registration form in .pdf format. REGISTRATION FORM.