SEBC MEMBERSHIP APPLICATION
	This applicaton will allow you to apply for membership and pay annual dues via Credit Card within a secured site. If you wish to apply for membeship by mailing in a printed application along with a check please use the Printable Application Form. As an applicant for membership in the Southern Employees Benefits Conference, I acknowledge that I have three years of employee benefits experience and my primary business address is in one of the states listed below. If accepted, I will attend Conferences whenever possible, I will abide by the Conference's non-solicitation policy, and I will serve on committees if so requested. The Geographic area of the Southern Employee Benefits Conference: Alabama, Arkansas, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia. *Required Information Professional Information Name*: Title: Business Mailing Address Address1 :* Address2: City:* State:* Zip:* Phone:* (xxx) xxx-xxxx Fax: (xxx) xxx-xxxx Email: Employer:* How Long?* Present Duties & Responsibilities: * If less than 3 years at current employer, please complete the following: Prior Employer: How Long? Duties & Responsibilities at Prior Employer:  Industry Discipline* Please select appropriate discipline: ACCOUNTANT INSURANCE PLAN SPONSER Health/Welfare Administrator ADMINISTRATOR (TPA) Retirement Plans Finance Health/Welfare Both Investments Retirement Plans Other Legal Both Management   Other     CONSULTANT INVESTMENTS ATTORNEY Actuary Client Services Health/Welfare Consultant TRUST Management Investment Banker Administration Retirement Plans Marketing Marketing Other Portfolio Manager Other Trust Other Expertise:* Retirement Plans Health & Welfare Both Annual membership dues for the Southern Employee Benefits Conference is U.S. $250. Please be sure all professional information is completed above. Upon submitting the application you will be directed to a secure site where you can enter your payment information. You will be notified in writing as to the decision on your application following the next meeting of the Membership and Steering Committees.  If membership is not granted or you wish to withdraw your application please notify SEBC and the application fees will be credited. Please view our Privacy Statement and Refund Statement before submitting your registration. Any questions should be directed to the Executive Director at the address below. Southern Employee Benefits Conference Attention: Beverly Friez 805 S. Glynn Street Suite 127 PMB 425 Fayetteville, GA 30214 Phone: (770) 461-0525 Back to Membership page