Join today for a special charter member annual rate of only $240. You save $120 off the normal annual rate of $360. New memberships start on the first of each month. At that time, you will receive your username and password to the members’ only website.

To signup for the Academy, please complete the following information and click the submit button.
SECTION A: BACKGROUND INFORMATION
If you were referred to the Academy, please type the name of the person who referred you:
Personal Information
Prefix:	Select Mr. Ms. Mrs. Dr.
First Name:
Middle Initial:
Last Name:
Suffix:
Company Information
Company Name:
Your Title:
Address 1:
Address 2:
City:
State:	Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming ----- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwestern Terr. Nova Scotia Ontario Prince Edward Island Quebec Sacketchewan Yukon
Zip:
Country:
Phone:
Ext.:
Preferred Fax:
Preferred E-mail:
Confirm E-mail:
Company URL:
Gender:	Select Male Female
Birthdate:	mm dd yyyy
SECTION B: LICENSES
NASD Securities Licensed:
Yes No
Designations (Check all that apply):
CFP® ChFC CLU CPA PFS CFA CTFA EA JD Other None
Profession "Clients generally view me as" (check one)
Accountant Attorney Banker Financial Planner Insurance Professional Investment Manager Planned Giving Specialist Stockbroker/Registered Rep Broker Dealer Executive Financial Services Corporate Executive/Wholesaler
SECTION C: PRACTITIONER INFORMATION
Size of Practice:	Select Up to $200,000 $200,000-$500,000 Over $500,000
Your Position:	Select Owner / Partner Employee Independent Contractor Other
Broker/Dealer Affiliation
Affiliated with:
(Please spell out name of Broker/Dealer - no abbreviations)
	No Affiliation
SECTION D: Code of Ethics
I agree to abide by the PEAK Academy of Wealth Managers’ Code of Ethics as written below.
1. I will always do what is in the client’s best interest 2. I will always follow all regulatory guidelines as it relates to running my business 3. When in doubt, refer to #1 and #2 above
	I agree to the Code of Ethics
SECTION E: PAYMENT INFORMATION
	Yes! Sign me up now
The normal annual fee for the PEAK Academy of Wealth Managers is $360. However, we are currently offering a Special Charter Member rate of only $240.
Promotional Code:
Credit Card Type:	Select Visa Mastercard American Express
Name as it appears on the Credit Card:
Credit Card Number (No "-" or spaces please):
CVV2/CID:
	This is the number printed in the signature area of the back of a Visa or Mastercard. It is the last 3 digits. This number is located on the front of an AMEX card to the upper right of the credit card number.
Expiration Date(mm/yy):