New Membership Form

Instructions

To complete your registration, please fill out this form with your personal and professional information. Once you have saved your information, please pay the $100 annual dues through Paypal using the Paypal button.

Important - Your membership will not be complete until dues are paid.

If you have any questions, please contact us at lpn@lifeplanningnetwork.org.

Thank you, and we look forward to having you as an LPN member!

NOTE: * are required fields.

Please create a user login and password. Your login can be up to 80 characters in length. Passwords are limited to 15 characters. For maximum security, use a mixture of characters and numerals. Using birthdays, your name, spouse's name, etc. is a bad idea.


*User Login:
*Password:
*Confirm Password:

Main Contact Information


*Organization:	Life Planning Network
*Membership Type:	National
Current Chapter Affiliation: ( if any )
*Prefix:
*First Name:
*Middle Name or Initial:
*Last Name:
*Suffix:
*Nickname:
*Preferred/Business Address:
*
*City:
*State:
*Zip:
*Country:
*Preferred Phone:	Ext.
*Fax:
*Preferred Email Address:
*Confirm Email Address:
*Primary Website:
*Secondary Website:

Business Directory Options

* Include me in the Public Directory
Business Directory Info

Professional Information

Please select one Primary Professional category that most closely reflects your area of expertise.
*Professional Category:
*Current Work Status:
*Employer/Company Name:
*Professional Title:
*Audience You Serve:
*Professional Credentials (e.g. CFP - Certified Financial Planner):
*Brief Professional Description: Public/Member Directory (1500 chars max.)
*Additional Professional Information: Member Directory Only (3600 chars. max.) (Please include links to blogs, books and articles you have authored, workshops you conduct, your Linked In public profile, your Facebook page, your Twitter address, requests for collaboration, or anything else you would like a member to know about you.)

Miscellaneous Information

*Interested in Volunteering? (Use the "Ctrl" key to select more than one.)

*Other Volunteer Interests:
*Available for Speaking Engagements? (Use the "Ctrl" key to select more than one.)

*Other Topics?

-- Select --
Business Services
Caregiving
Coaching/Life Coaching
Community-Based Services/Non-Profit Service Provider
Creativity
Education/Life Long Learning
End of Life and/or Legacy
Financial
Government
Health and Wellness
Housing and Lifestyle
Journalist/Writer/Researcher
Legal
Leisure andTravel
Life Planning/Retirement Planning
Paid Work/Career
Professional Association
Spirituality
Technology
Therapy/Counseling
Volunteer/Civic Engagement
Other

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New Membership Form