SEBC MEMBERSHIP RENEWAL

To assure your listing in the next Membership Directory (to be published and updated on-line), please provide the information requested below. If you wish to renew your membership by mailing in a printed application along with a check please or credit card information please use the Printable Membership Renewal Form.

 

*Required Information

Professional Information
Name*:
Title:


Business Mailing Address
Address1 :*
Address2:
City:*
State:*
Zip:*

Phone:* (xxx) xxx-xxxx
Fax:
 (xxx) xxx-xxxx
Email:

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 US $250. Please be sure all professional information is completed above. Upon submitting your renewal request you will be directed to a secure site where you can enter your payment information.

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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