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Name: ___________________________________________________________________
Title: _____________________________________________________________________
Business Mailing Address:__________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Business Telephone: ____________________ Fax: ______________________
E-mail Address: ____________________
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 |
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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 ________
ANNUAL DUES: US $250.00
To assure your listing in the Membership Directory (to be published
and updated on line), return this remittance invoice along with your
check or credit card information.
Remit to:
Southern Employee Benefits Conference
805 S. Glynn Street
Suite 127 PMB 425
Fayetteville, GA 30214
CREDIT CARDS ACCEPTED: American Express _____ Discover _____ Master
Card _____ VISA _____
Credit Card Number: ______________________________ Expiration Date:
__________
Name as appears on card: ____________________________________
(Please Print Name)
Signature:__________________________________ Date:_________________________
LIST ANY ADDITIONAL CORRECTIONS TO YOUR MEMBERSHIP INFORMATION HERE:
Please do not e-mail personal account information as our e-mail
address is not a secure site.
Southern Employee Benefits Conference
805 S. Glynn Street
Suite 127 PMB 425
Fayetteville, GA 30214
Telephone: (770) 461-0525 Fax: (770) 461-8052
Web Site: www.sebc.org
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