2011 WAPG New Membership Application!
(New members and students fees are $75.00 per year. Renewal fee is $100/year)
Click here to download the WAPG New Membership Application
NAME ________________________________________ CPG#___________________
MAILING ADDRESS _____________________________________________________
CITY ___________________________ STATE____________ ZIP_________________
EMAIL ADDRESS _______________________________________________________
WEB ADDRESS ________________________________________________________
PHONE ______________________________ FAX _____________________________
Employment Type _____ Independent CPG _____ in CPG Agency
CPG AGENCY NAME ______________________________________ CPGA#____________
Number of CPGs in the Agency ___________
Committee on which you are willing to help:
____ Spring Seminar: Plan 6 hour seminar for CPGs: date, place, program
____ CPG Board monitoring: Attend CPG Board meeting and provide summary to list serve
____ GR 23: Advise CPG Board and Supreme Court on “Practicing Guardian” definition
____ WAC 388: Work with Legislature or DSHS to increase $175, eliminate MNIL limit on fees, conform notice to court rules
____ Medicaid Client Data collection: maintain data on Guardianship clients with Medicaid to provide information to interested parties
____ Insurance: review CPG Board requirement
____ Membership: encourage CPGs to join and participate in WAPG
____ Other issue: ________________________________________________
Enclose check for $75.00 as application fee. Mail to:
WAPG
12613 BEVERLY PARK ROAD
LYNNWOOD, WA 98087