Application and Payment for the CLRP Designation and Membership

Your Age:


  Do you have at least 4 years of college education?
  Do you have at least 4 years in activities or a profession related to the CLRP?


  • Elder law or Estate planning
  • Home care services
  • Reverse mortgage
  • Care management
  • Financial advice or products for the elderly
  • Veterans benefits
  • Working in a care community or nursing home
  • Care community placement services
  • Any other activities or profession focused on
    helping aging seniors and their families
  Do you have a cumulative of college education and activities or a profession listed above that total at least 4 years combined?

Convictions / Suspensions / Judgments

  Have you ever been convicted or imprisoned for a crime?
If yes,
please explain
  Have you ever had a state or federal license revoked or suspended?
If yes,
please explain
  Do you have any judgments against you?
If yes,
please explain

Certification / Submit Application

  With your eSignature (accepted in the form of /your full name/), you certify the statements and entries above are true and correct to the best of your knowledge.
What is 2 + 2?*
  We strive to prevent spam. Answer the question above to show you are human.
Required = *
  We respect your privacy. Your information will not be given / sold to any other entity.