Page 1 of 4

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


CONTACT INFORMATION
Please include attorney's full name.
Please include attorney's full name.
Invalid Input
Please include business address
Please include office phone number.
Invalid Input
Please enter a valid email address
Invalid Input


PROFESSIONAL INFORMATION
Invalid Input
Invalid Input
Invalid Input
Invalid Input
(If less than 5 years, complete application on mentor.)

Invalid Input
Invalid Input
Areas of expertise (Personal, Estate & Trust, Corporate)
Invalid Input
(If any areas less than 5 years, complete application on mentor.)

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



FIRM INFORMATION
Invalid Input
Invalid Input
If there are any attorneys or insurance or investment professionals, how many of each category?
Invalid Input
Invalid Input
Invalid Input


ONGOING EDUCATION AND LEVELS OF ACHIEVEMENT
Invalid Input


TEAM MEMBERS
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.
Invalid Input
Invalid Input


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.
You must verify that you agree to the terms and conditions by checking this box to proceed.

Copyright © 2015-. All rights reserved. Reproduction is strictly prohibited.