Attorney Application

Our objective at the Retirement Education and Resource Center of North America, Inc. (RERCNA) is transparency of individuals that meet and represent the opinions and guidelines within Positioning 4 Retirement, allowing the reader a basis for selecting a team of professionals.

By completing and signing this application, it allows RERCNA an opportunity to contact and discuss your professional and personal character as presented in your answers to the questions. You agree to hold Positioning 4 Retirement and its entities and administrators harmless of incident or issues that may arise due to the completion of this application.

Fields marked with * are required.

GEOGRAPHICAL PREFERENCE

What geographical area would you like to represent? Please list general area(s) such as Boston, Cape Cod, western or central Massachusetts, etc...:*

Please list at least one area you would like to represent.

CONTACT INFORMATION

First name:*

Please include attorney's full name.

Last name:*

Please include attorney's full name.

Law firm:*

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Business address:*

Please include business address

Office phone number:*

Please include office phone number.

Mobile phone#:

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Email address:*

Please enter a valid email address

Website address:

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PROFESSIONAL INFORMATION

State(s) licensed: (hold Ctrl+ key to select more than one.)*

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How long have you been practicing law?*

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Professional designations

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Areas of expertise (defense, litigation, family law, estate planning, Medicare, etc.):

Please list each area of expertise, years practicing each, and % of time devoted to each.

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Other licenses held (CPA, securities, insurance, etc.)

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If you hold other licenses:

Are you paid for providing a service utilizing the other license(s)?

Yes No Invalid Input

If yes, how do you disclose your compensation to the client?

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If yes, is your first position of representation as an attorney?

Yes No Invalid Input

If your answer is no, please complete an application representing each license.

If you work for or represent a financial institution (bank, investment company, insurance agency, etc.), what is the name and web address of the institution?

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May we contact the institution to discuss your position with them?

Yes No Invalid Input

If yes, please provide a name and contact information:

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Please list associations you are a member of:

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FIRM INFORMATION

If you are a member of a firm, how many attorneys are there?

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If there are any CPAs or insurance or investment professionals, how many of each category?

CPAs:

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Insurance Professionals:

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Investment Professionals:

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ONGOING EDUCATION AND LEVELS OF ACHIEVEMENT

List continuing education courses taken in the past 3 years. Include courses that do not offer CE credits. Include, course title, instructor, organization offering course, and a brief description.

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TEAM MEMBERS

Do you currently have an organized team of professionals?

Yes No Invalid Input

It is not necessary for you to have an assembled team; however, if you have a team or a partial team, we would like to know.

Please provide us a list of any professionals on your team and include their area of expertise (attorney, CPA, investment advisor, or insurance advisor), their website url, and whether or not they have applied to P4R (if known.)

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Additional Comments

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DISCLAIMER

It is RERCNA’s objective to seek transparency within the individuals that meet and represent the opinions and guidelines within the book, Positioning 4 Retirement, allowing the reader a basis for selecting a team of professionals.

By checking the agreement below, you allow RERCNA to contact and discuss your professional and personal character as presented in your answers to the above questions. You also agree to hold RERCNA, its affiliates, website partners, publication partners, and other team members harmless from and against any loss, incidental, special or consequential damage, liability, cost, or expense for any negligent or wrongful act or omission or misrepresentation by RERCNA relating to the information from this application or any of its links including, without limitation, reasonable attorney’s fees.

Checking the box below constitutes an electronic signature:*

I agree to the above disclaimer and the terms & conditions of Positioning4Retirement.com. You must verify that you agree to the terms and conditions by checking this box to proceed.

Attorney Application

Contact Info