Membership Application

Membership in the Life Care Planning Law Firms Association is held by the law firm rather than by an individual attorney. Member law firms may be any type (sole practice, partnership, corporation, PLC) of law firm whose attorney(s) are licensed and in good standing with the Bar Association (and regulatory agency(ies) if any) of the state(s) in which it practices, and which is engaged, or intends to be engaged, in the elder-centered holistic law practice of Life Care Planning as defined by the Association. Each applicant law firm is to identify a Representative, who is a principal, partner, or employee of the firm, who is identified and empowered as the firm’s primary contact to the Association.

Applicant law firm information:

Name of Law Firm *

Street Address *

City *

State *

Zip Code *

Telephone *

Fax

Website

Documentation for Membership Requirements

A. Fundamental concepts of Life Care Planning

Participation in Life Care Planning fundamentals training as approved and sponsored by the Association by at least one attorney who is an owner, partner, or employee of the firm within 45 days of becoming a member.

Firm has had a Care Coordinator on staff for at least two years prior to submitting this application.

Firm has demonstrated its commitment to elder-centered life care planning for two years prior to submitting this application. Firm has been practicing elder-centered life care planning for the past two years or more, and is fully committed to the principles and practices of Life Care Planning as defined by the Association. Signature of the pledge of commitment below affirms this commitment.

One is required. Please check the box for the applicable requirement and provide requested information:

B. Employment of care coordinator

Firm employs at least one care coordinator, care manager, or person with similar responsibilities as at least a part-time employee of the firm.

Firm does not currently employ a care coordinator but intends to hire one on at least a part-time basis within two years of approval of this application. Signature of the pledge of commitment below affirms this intent.

Name of Trainee

Date of Training

Name of Care Coordinator

Date Hired

Name of Person

Position Title

Email Address *

Employment Status

Regular employee (full or part time)

Relative of owner/partner

Contract employee whose services are committed to the firm

Other

If Other, please describe

C. Identification of firm's Representative to the Association The Representative must be an attorney who is a principal, partner, or employee of the member firm.

Name

Position with Firm

Contact Information

Mailing Address

City

State

Zip Code

Phone

Fax

Email Address

D. Pledge of commitment to the principles of the Association *

I Agree

I, or another attorney of the firm, will complete the fundamentals training program in Life Care Planning sponsored by the Association within 45 days of becoming a member and/ or the firm has practiced elder-centered life care planning for a minimum of two years. My firm understands and endorses the principles and practices of Life Care Planning as defined by the Life Care Planning Law Firms Association. My firm is committed to Life Care Planning as a holistic legal practice which anticipates and provides legal and care advocacy services to our Life Care Planning clients as their circumstances and needs change. My firm is committed to helping our Life Care Planning clients and their families navigate the long-term care and health care system, and to advocate for good care during their loved one’s journey through the elder care continuum. My law firm is licensed and is in good standing with the Bar Associations and governmental regulatory agencies in the states in which we practice. My firm commits to adhere to the principles and practices of Life Care Planning as defined by the Association, and to meet all responsibilities and obligations of membership in the Association.

Name of Signer *

Position with Applicant Firm *

E. Extraordinary circumstances to be considered when reviewing this application

Our State Bar Association requirements prohibit us from employing a Care Coordinator as a direct employee of our firm.

Other extraordinary circumstances

In certain extraordinary circumstances, membership may be approved when all membership requirements are not met. If this application merits consideration due to extraordinary circumstances, please identify and describe them below

We are handling the Care Coordinator responsibilities as follows

Please Describe

F. Payment of membership fee and annual dues *

Check mailed separately

Check enclosed with this application

I have completed the credit card form (download below)

Membership fees and annual dues are good for the calendar year as described below. Membership must be renewed annually. Membership fees and annual dues are established by the Association’s Board of Directors and are subject to change. For applicants whose application is received between November 1, 2022 and June 30, 2023 the membership fee is $1,100.00 for membership through December 31, 2023. For applicants whose application is received between July 1, 2023 and October 31, 2023, the membership fee is $550.00. Applicants whose applications are received between November 1, 2023 and June 30, 2024, membership fees shall be as established by the Board of Directors for the 2024 calendar year and membership is valid through December 31, 2024. To pay by credit card, please download the form and mail to: Life Care Planning Law Firms Association c/o The Carlson Group, LLC, 8987 E Tanque Verde Rd Tucson, AZ 85749 or FAX to 814-286-3953

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