APPLICANT INFORMATION

Last Name:

First:

M.I.:

DOB:

Street Address:

City:

State:

Zip:

Country:

Phone #:

Cellular #:

Email:

EMPLOYMENT

Present Employer:

Type of Business:

Date Started:

Current Position:

Business Street Address:

Business City:

Business State:

Business Zip:

Business Country:

Business Phone #:

Business Cellular #:

REFERENCES

Please list three references who can attest to your character and financial planning ability in your respective field.

1.) Full Name:

Relationship:

Company:

Phone #:

Address:

2.) Full Name:

Relationship:

Company:

Phone #:

Address:

3.) Full Name:

Relationship

Company:

Phone:

Address:

PREVIOUS EMPLOYMENT

1.) Company:

Phone #:

Address:

Job Title:

Responsibilities:

From:

To:

Type of Business:

2.) Company:

Phone #:

Address:

Job Title:

Responsibilities:

From:

To:

Type of Business:

3.) Company:

Phone #:

Address:

Job Title:

Responsibilities:

From:

To:

Type of Business:

EDUCATION

High School:

Major:

Graduation Date:

City/State/Country:

Undergraduate School

Major:

Graduation Date:


City/State/Country

Graduate School:

Major:

Graduation Date:


City/State/Country:


Other:

Major:

Graduation Date:


City/State/Country

LISCENSES/REGISTRATIONS/CERTIFICATIONS

Attorney:

Date Licensed:

State/Country:

Insurance License #:

Date Licensed:

State/Country:


Real Estate License #

Date Licensed:

State/Country:

Securities License #:

Date Licensed:

State/Country:

Brokerage Firm:

Date Licensed:

State/Country:

Finance:

Date Licensed:

State/Country:

CPA/Tax Accounting:

Date Licensed:

State/Country:

Banking:

Date Licensed:

State/Country:

Other:

Date Licensed:

State/Country:

TRAINING

List any training completed in any of the specialties from above. Provide dates and number of credit hours received (Include any company training

Training:

Date Completed:

Credit Hours:

Training

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

Training:

Date Completed:

Credit Hours:

MISC.

Has your membership/license to any organization ever been suspended or revoked.

YES

NO

If yes, give brief explanation:

Has there ever been any disciplinary action taken against you?

YES

NO

If yes, give brief explanation:

Please provide any other information which you feel may be helpful (additional education, methods used, list of represented clients, list of credentials that you submit to your clients.

CHECK THE DESIGNATION YOU ARE APPLYING FOR:

 AFFILIATE MEMBERSHIP (NON-DESIGNATED)

REQUIREMENTS
 > Upon acceptance of an Affiliate membership, the applicant agrees to complete a 120 hour course of study, that RFPI recognizes, within two (2) years.

COST: $125.00 (USD)
> $75.00 (USD) Annual Dues
> One time processing fee of $50.00 (USD)

MEMBERSHIP BENEFITS
> Ability to upgrade to the RFP ® designation once meeting all educational and experience requirements.
> Personalized membership card
> A subscription to the RFPI ® online newsletter
> Listing on the RFPI ® member website

 RFP® : REGISTERED FINANCIAL PLANNER®

REQUIREMENTS
 > Must have at least two (2) years financial planning experience in their respective field. a 120 hour course of study, that RFPI recognizes, within two (2) years.
> Must have already completed 120 hours of approved education, and show evidence of passing exams related to area(s) of expertise.

COST: $200.00 (USD)
> $150.00 (USD) Annual Dues
> One time processing fee of $50.00 (USD)

MEMBERSHIP BENEFITS
> Personalized RFPI ® designation, wall certificate, and membership card
> RFPI Logo stickers & Lapel pin
> Listing on the RFPI ® member website
> Subscription to the RFPI ® online newsletter
> Free advertising for your company and services (restrictions apply)> Discussion group and blog participation

PAYMENT OPTIONS

_________Check /International Money Order enclosed (I understand my cancelled check will be my receipt)

_________Credit card payment (Visa or MasterCard) please complete the information below;

Amount to be charged to credit card $_____________________

Card Number _____________________________________________Expiration Date _________________

Name as it appears on card: ________________________________________________________________

Signature to authorize the charge on credit card:________________________________________________

AGREEMENT: PLEASE READ CAREFULLY

1. I understand that I may not use the RFP designation or its logo or advertise myself as a RFP ® until I have received official notification of my approval.

2. I hereby authorize investigation of all information I provided in my application.

3. I understand that permission to use the RFP ® and its logo are granted for a period of 1 year unless specified. At the of such period if the designation is not renewed then any use or right to use has expired and continued use would be considered a violation. Penalties, by way of re-instatement fees may be imposed if a member renews after renewal period.

4. I agree to maintain proficiency in my work by completing a minimum of 20 credit hours of continuing education in my field of financial planning and to supply proof to RFPI ® during the 3 year reporting period.

5. I understand that the RFPI ® Board has the absolute and unrestricted right to revoke any rights I have to use the RFP ® designation. I understand that failure to comply with any of the RFPI ® Code of Ethics could result in forfeiture of the designation.

If your application is approved for membership and you are granted use of RFP ® designation, your confirmation can be sent by email if requested.

Please confirm email address here: ________________________________________

*Please be sure to include copies of supporting documents when submitting the completed application: Resume or CV (not required but preferred) copies of any professional licenses, registrations, certifications & other designations, please provide evidence of education completed (copy of transcripts/diploma) personal photo & payment. Incomplete applications will not be processed.

All applications must be signed by applicant.

RFP ® membership packets are sent within 7 -10 days of board approval, (receipt for credit card payment will be included inside membership packet.)

Please Read the Following Statement as well as the Agreement on previous page before signing:

I hereby submit this application to the Registered Financial Planners Institute ® and verify that all information to the best of my knowledge is accurate and complete. If approved, I shall abide by the rules, regulations and Code of Ethics of the Registered Financial Planners Institute ®. I also agree to attend a minimum of 20 hours of continuing education every three (3) years in my respective field and supply proof of credits earned to the Institute during the required reporting period. I also understand that my name, specialty and contact information will be shown on the Internet unless specifically requested. If not approved, I understand that I will be refunded my application fee.

Signature of Applicant__________________________________________  Date _____________________________

Please provide the name of the RFP ® member who referred you: ___________________, or how you learned of
RFPI ® : _________________

Please sign below if you do not want your information shown on Registered Financial Planners ® website in the member directory.

I prefer NOT to be listed on the Internet at this time: __________________________________________________

Changes can be made at any time to your member listing by calling 440-282-7176 or sending email at info@rfpi.com.

RFPI® Designation & Membership Application Rev. 2/09