Member Registration First Name:*Last Name:*Name as it should appear on tag*Password* Enter Password Confirm Password Type*NewTransfer*Re-Entry**Professional Discipline*AccountantActuaryAdministrator (TPA) Health & WelfareAdministrator (TPA) Retirement PlansAdministrator of Both Health & Welfare and Retirement PlansLegalInvestments*AdvisorClient ServicesMarketingPortfolio ManagerConsultant*Health & WelfareRetirement PlansBothOtherPlan Sponsor*AdministratorManagementFinanceOtherInsurance*Health & WelfareRetirement PlansBothOtherTrust*AdministratorMarketingFinanceOtherCompany*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*FaxTitle*Description of duties/responsibilities relating to Employee Benefits*Approximate percentage of time devoted to Employee Benefits*Sponsoring LEBC Member*Membership Dues:Payment Date: Dues Payment*Jan. 1-Jun. 30 $ 395.00 (dues through 12/31)Jul. 1-Oct. 31 $197.50 (dues through 12/31)Nov. 1-Dec. 31 $ 460.00 (includes next year’s dues)Sub-Council Membership Dues* Retirement Plan Sub-Council Heath and Welfare Sub-Council Total Price: $0.00 Total Price: $0.00 Total Price: $0.00 If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Membership in the Louisville Employee Benefits Council must be renewed annually. If you are already a member seeking to renew your membership, please see our Invoice Form. Type: New * Transfer Transferor Re-Entry