SEBC MEMBERSHIP APPLICATION

This application will allow you to apply for membership and pay annual dues via Credit Card within a secured site. If you wish to apply for membership by mailing in a printed application along with a check please use the Printable Application Form.

As an applicant for membership in the Southern Employee 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.

As a member of the SEBC, I agree to receive periodic emails from the Southern Employee Benefits Conference.

The Geographic area of the Southern Employee Benefits Conference includes: 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.

As a member of the SEBC, I agree to receive periodic emails from the Southern Employee Benefits Conference.

Please view our Privacy Statement and Refund Statement before submitting your registration.

Credit Card Number: *
Security Code: *
(3 digits on back of MC/Visa; 4 digits on front of Amex)
Expiration Date: * /
Card Holder First Name: *
Card Holder Last Name: *


Any questions should be directed to the Executive Director at the address below.

Anne McKillips
Southern Employee Benefits Conference
3334 Peachtree Rd. NE Suite 709
Atlanta, GA 30326
Phone: (404) 812-9132
Fax: (404) 240-0158
E-mail address: amckillips@sebc.org

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