California Advocates for Nursing Home Reform

1803 6th Street | Berkeley, CA 94710 | 415 - 974 - 5171 | Fax 415 - 777 - 2904

Application For Elder Law Panel Membership

Please Note: All of the following statements must be true for you in order to qualify for CANHR's Elder Law Panel Membership:

I am not licensed to sell insurance products.
I have not been disciplined by the state bar.
I am continuously covered by a policy of errors and omissions insurance of at least $100,000 for a single occurrence & $300,000 aggregate per year.

Please continue with the form below if the above statements apply to you.

Title:

State Bar #:

First Name:

Last Name:

Address:

City:

State:

Zip:

Email:

Website:

I am requesting the following applications:

Estate Planning for Long Term Care Panel

EADACPA and Elder Abuse Specialization Panel

Conservatorship Panel

Elder Fiduciary Abuse Panel Application Special Needs Trust PanelPatients' Rights Panel Application

CANHR is a 501(c)(3) organization; contributions are tax–deductible to the extent allowed by law. If you would like to make a donation to CANHR, you can click on the button below which will open our donation page in a separate browser tab.

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