Application for Affiliation - NAPFA

Application for Affiliation
Applicants for Financial Services Affiliate status should include a check for $450 with this completed application which
includes a $100 non-refundable processing charge. Individuals employed by a firm with at least one other NAPFA member do
not need to pay the processing fee. Applicants for Academic Affiliate status should include a check for $150 and applicants
for Student Affiliate status should include a check for $100. Full-time college/university students in financial planning related
degree programs are eligible for a 65% discount to the $100 annual dues. If an applicant is not accepted as a Financial Services
Affiliate, $350 will be refunded. There is no application processing fee for Academic or Student Affiliates.
Annual affiliate renewal takes place the month of your birth each year. Annual dues payable for a individual’s first renewal
year will be prorated to reflect the month in which membership commenced, and to account for any dues discount available
through multiple NAPFA memberships or affiliations in one firm.
Category of NAPFA affiliation for which this application is made:
Financial Services Affiliate Academic Affiliate Student Affiliate
Name:
Firm :
Address:
Phone: Fax:
E-mail: Web site:
Mailing address, if different from above:
Birth Date S/S # xxx-xx- (last four digits only)
Professional credentials or designations:
Year and capacity in which you entered the financial services industry:
Year you began providing comprehensive financial planning services:
Year you began providing comprehensive Fee-Only financial planning services:
NASD licenses you currently hold: Your CRD #
Please furnish a letter from B/D housing your licenses stating that no fees or commissions are being paid to you.
Do you participate in a NAPFA Study Group If so, which group
Did a NAPFA member refer you to the organization Yes _____ No _____ If so, who ___________________________
1
September 2006

Form ADV Include as Attachment A a copy of your current Form ADV and all Schedules. If you are not registered, attach a
detailed explanation as Attachment A. State the date, status and file number of your registration as an investment adviser or
investment adviser representative.
*Not needed if employed by a firm with at least one other NAPFA member.
Regulated by SEC or State
File number
Date of current registration
Status
Education Provide the name and location of each accredited institution from which you have received a degree, showing the
date and discipline of each degree. An applicant for Student Affiliation status should provide information concerning the
degree/designation that is expected to be received and when applicant started in the educational program. As Attachment B,
an applicant for Student Affiliate status should include evidence of candidacy in a financial planning or related curriculum.
Name of Institution Location Degree and discipline Year conferred
Employment Please describe your current employment, including title, institution, length of service and a general description
of your duties.
Affiliate Status Please check the category appropriate to your application.
Financial Services Affiliate. By signing this document, an applicant certifies that he or she is a Fee-Only professional
in a financial services or related industry.
Academic Affiliate. By signing this document, an applicant certifies that he or she is a faculty member in a financial
planning program or a related field at an accredited institution of higher learning.
Student Affiliate. By signing this document, an applicant certifies that he or she is a student enrolled in an academic
course of study in pursuit of a degree/designation that will lead to a financial planning career. The student may be employed
by a Fee-Only financial planning firm. An applicant further certifies that he/she is a degree/designation candidate at the
accredited institution of higher learning named above. Applicants for this category of affiliation are not required to have this
document notarized.
Additional Information If you believe that additional information would be helpful to the NAPFA Membership Committee in
its evaluation of your application, please feel free to include that information as Attachment C.
September 2006
2

Fiduciary Oath
• I shall act in good faith and in my client’s best interest at all times.
• I shall provide written disclosure to my client of any conflicts of interest that may compromise my impartiality or
independence.
• I shall not accept any referral fees or compensation that is contingent upon the purchase or sale of a financial product.
Acknowledgement and Certification
I acknowledge that NAPFA may obtain copies of my regulatory filings, including but not limited to Form ADV. NAPFA may
review my disciplinary history, order a credit check, verify my education and other credentials, and may require that I submit
client and/or professional references, as an element of this application.
I certify and affirm that I have read, understand and agree to be bound by the NAPFA Fiduciary Oath, Code of Ethics and
Standards of Membership and Affiliation set forth above. I certify that all of the statements and responses, and every attachment
hereto, are full and complete and contain all material information and omit no material information relevant to my application
for membership in NAPFA. I agree to hold harmless NAPFA, its Board of Directors and its employees and agents, in the
event that my application for membership is not accepted, or my membership is terminated or not renewed for any reason.
___________________________________ ___________________________________ _____________________
Signature of Applicant Print name Date
Sworn and subscribed to me this _______ day of _____________, 200_____.
__________________________________
Notary Public
State of
County of
My commission expires
3
September 2006

AFFILIATION APPLICATION CHECKLIST
Please remember to include the following with your application. Incomplete applications cannot be processed.
Attachment A
Not needed if employed by a firm with at least one other NAPFA member.
Copy of completed and filed Form ADV, including Part I, Part II and all Schedules filed within
the most recent 12 months;
OR
Explanation of non-registrant status.
Attachment B, for Student Affiiate Applicants
Degree candidacy information.
Attachment C, if applicable
Additional information.
Check for Dues and Application Processing
Financial Services Affiliate — $450*
$350 if employed by a firm with at least one other NAPFA member.
*$350 dues plus $100 application processing fee
Academic Affiliate — $150
Student Affiliate — $100
Full-time College/University Student — $35
Please send pages 1-4 with all attachments and your check to:
Membership Manager
National Association of Personal Financial Advisors
3250 North Arlington Heights Road, Suite 109
Arlington Heights, IL 60004
September 2006
4