FEA PROGRAM APPLICATION Fall 2021 Virtual Cohort Starts September 23rd, 2021

FEA PROGRAM APPLICATION

Fall 2021 Virtual Cohort
Starts September 23rd, 2021

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

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.

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.

Please check the box below to continue

I AGREE

PAYMENT OPTIONS | FEA PROGRAM | 2021

*All fees are subject to applicable taxes

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

Fall 2021 Virtual Cohort – Program Start Date: Sep 23, 2021

One-Time Payment Option	$15,965*			Grand Total
Payment Due Date	Aug 13, 2021			$15,965*
Payment Plan Option	1st Installment	2nd Installment	3rd Installment	Grand Total
Payment Due Date Installment Amount	Aug 13, 2021 $5,390*	Oct 29, 2021 $5,390*	Mar 31, 2022 $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

PROFESSIONAL DETAILS

Current Job Title (enter unemployed if currently not working)

Organization Name (enter Independent if you do not have an organization name)

Portion of Practice Involving Families in Business

Primary Area of Practice (select one choice)

Additional Area of Practice (select one choice)

Website

E-mail

Alternate E-mail

Employer Address Line 1

Employer Address Line 2

Employer Address Line 3

Employer City

Employer Province/State

Employer Postal/Zip Code

Employer Country

Telephone (Please include extension if applicable)

Mobile Phone

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