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.
Name: ___________________________________________________________________
Title: _____________________________________________________________________
Business Mailing Address:__________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Business Telephone: ____________________ Fax: ______________________
E-mail Address: ____________________
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 |
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Please circle appropriate discipline: |
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ACCOUNTANT |
INSURANCE |
PLAN SPONSOR |
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Health/Welfare |
Administrator |
ADMINISTRATOR (TPA) |
Retirement Plans |
Finance |
Health/Welfare |
Both |
Investments |
Retirement Plans |
Other (please specify) |
Legal |
Both |
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Management |
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INVESTMENTS |
Other (please specify) |
CONSULTANT |
Client Services |
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Actuary |
Consultant |
ATTORNEY |
Health/Welfare |
Investment Banker |
|
Management |
Marketing |
TRUST |
Retirement Plans |
Portfolio Manager |
Administration |
Other (please specify) |
Trust |
Marketing |
| Other (please specify) |
Other (please specify) |
Expertise: Retirement Plans ________ Health & Welfare _________ Both ________
Signature ____________________________________________________________________
Please enclose dues check payable to "Southern Employee Benefits
Conference" with this application in the amount of $250 and mail
to the address below. Please do not e-mail personal account information
as our e-mail address is not a secure site.
CREDIT CARDS ACCEPTED: American Express _____ Discover _____ Master
Card _____ VISA _____
Credit Card Number: ______________________________ Expiration Date:
__________
Name as it appears on card: ____________________________________
(Please Print Name)
Signature:__________________________________ Date:________________________
You will be notified in writing as to the decision on your application
following the next meeting of the Membership and Steering Committees.
Any questions should be directed to the Membership Chair 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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