FEA PROGRAM APPLICATION Winter 2021 Virtual Cohort Starts Jan. 18th, 2021

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LEGAL INFORMATION

PRIVACY NOTIFICATION

COLLECTION AND USE: The personal information you provide to us during this application process is collected and used for purposes relating to the Family Enterprise Advisor (FEA) Program under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FIPPA).

EXTERNAL STORAGE: This application process is managed using online service providers. By submitting your application, you are consenting to the collection and storage of your information on servers located in the United States.

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PAYMENT OPTIONS | FEA PROGRAM | 2021

*All fees are subject to applicable taxes

*Program fee includes tuition, all reading materials, FEA examination fee and one-year complimentary membership in Family Enterprise Xchange

Winter 2021 Virtual Cohort – Program Start Date: January 18th, 2021

One-Time Payment Option	$15,965*			Grand Total
Payment Due Date	30 Days Prior to Start of Program (Nov 30th, 2020)			$15,965*
Payment Plan Option	1st Installment	2nd Installment	3rd Installment	Grand Total
Payment Due Date Installment Amount	30 Days Prior to Start of Program (Nov 30th, 2020) $5,390*	Apr 16th, 2021 $5,390*	Aug 27th, 2021 $5,390*	$16,170*

Please select your preferred payment option

One-time paymentPayment-Plan Option

PERSONAL DETAILS

Title

First Name (e.g. Robert)

Preferred First Name (name by which you are commonly known by, if different from the above e.g. Rob)

Last Name

Gender

How did you hear about us?

Please list your referral (name of person/organization)

Please list the specific conference/event

Other details

Dietary Restrictions

BILLING INFORMATION
Please specify how you would like invoices to be made out if different from previous.

Billing Organization Name

Billing Address Line 1

Billing Address Line 2

Billing City

Billing Province/State

Billing Postal Code/Zip Code

Billing Country

E-Mail Address of Billing Contact

Telephone Number of Billing Contact (include extension if applicable)

DESIGNATIONS

Please select the number of designations you have

Designation 1

Abbreviation

Full Name of Designation

Conferment Year

Designation 2

Abbreviation

Full Name of Designation

Conferment Year

Designation 3

Abbreviation

Full Name of Designation

Conferment Year

Designation 4

Abbreviation

Full Name of Designation

Conferment Year

Designation 5

Abbreviation

Full Name of Designation

Conferment Year

ADDITIONAL TRAINING OR PROFESSIONAL CERTIFICATIONS

Please select the number of certifications you have

Certification 1

Full Name