Mail-In or Fax-In > IAQFP.org Registration Form
E-mail Address *
Personal IAQFP Password *     
First Name *
Middle Name/Initial
Last Name *
Business Info:
Company Name
Broker/Dealer
Street Address *
Suite
City *
State *
Zip Code *
Country *
Phone *
Fax
URL
Services Description
Home Address Info:
Street Address *
City *
State *
Zip Code * 
Country *
Phone *
Fax
Identifying Info:
SS # or Country ID #  *
Date of Birth (Yr/Mo/Day) *
CIRCLE or Write in Your Qualifying Designation(s) *
    ChFC        CFP®       PFS         MSFS         MS 
Designation/Student ID# *
    ChFC        CFP®       PFS         MSFS         MS  
Date Designation(s) Earned *
    ChFC        CFP®       PFS         MSFS         MS  
Website Password to Verify American College Designations (new req.) * ALTERNATIVELY you can mail or Fax your Diploma/Certificate to:  1.877.346.3037, along with this completed Form.
List Other Designations  
          CPA, Esq., CLU, RFC, etc.
Insurance Licenses  License #                        Date Issued

Life

            

Casualty

            
Are you a Registered Investment Adviser  YES               NO            (circle one)
Registered Investment Adviser Name
Are you an Investment Adviser Representative  YES               NO            (circle one)
Represented Broker Dealer
 

Type of Registration (Circle One) & Payment Method

Member:                      Premier ($100)          Basic ($75)
Promo Code (if any):

Non-Member (N/C):    Registry "Listee" (Name and Designation Only)
Non-Member applicants please initial here  ______ if you also wish to purchase a 3 color, wall-mountable, QFP Designation Certificate ($10).
 
 
Credit Card #: Expiration Date:

[CARDMEMBER agrees to perform the obligations set forth by the CARDMEMBER'S Agreement with the Credit Card issuer, and hereby authorizes above charges to CARDMEMBER'S account by IAQFP].
 

Initial here ______ that you have read and accept the following:
   IAQFP Membership Agreement (Member Applicants Only)
   QFP Designation Usage Requirements and Advertising Guidelines (All Applicants)
   IAQFP Code of Ethics and Professional Conduct (All Applicants)
   IAQFP Disciplinary Procedures & Complaint Process (All Applicants)
   IAQFP Continuing Education Requirements (All Applicants)

 

Sign Here: x   __________________________     Dated:  __________
 

Mail or Fax (1.877.346.3037), along with your documents & fees, to:
 IAQFP, PO Box 7007, Beverly Hills, CA  90212-7007