2012 Member Application

Guardian/Conservator Association of Oregon
Membership Application/ Renewal 2012

^{Please note, this information will appear on the member list of our website.}

Please fill out and print form and mail with your check to:

GCA of Oregon
PO Box 2587
Oregon City, Oregon 97045

email address: Leave this field email-address blank:
Homepage: Leave this field homepage blank:
URL: Leave this field url blank:
Comment: Leave this field comment blank:

Name*:
Business or Organization*:
Address*:
State*:
Zip*:
Phone*:
Fax:
Email*:
Are you an attorney?:
Are you a nationally certified Guardian and Conservator?:
Are you an Oregon Certified Professional Fiduciary?:
Please select your membership preference
Memberships:	Individual - One name, one vote $75.00 Non-Profit/Gov't - Two names, two votes $125.00 Associate - Volunteers, family members, retired guardians, 3rd members of non-profits (one vote) $50
If you selected Non-Profit/Government, please provide the name and contact information of your free second member
Name:
Address:
State:
Zip:
Phone:
Fax:
E-mail:
Attorney?:
Nationally Certified Guardian and Conservator?:
Oregon Certified Professional Fiduciary?:
_
If you do NOT want your information to appear on our website, please select this checkbox:

This page was last modified on 01/24/2012

Guardian/Conservator Association of Oregon

2012 Member Application

Guardian/Conservator Association of Oregon Membership Application/ Renewal 2012

Guardian/Conservator Association of Oregon
Membership Application/ Renewal 2012