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Application For Elder Law Panel Membership

Please Note: All of the following statements must be true for you in order to qualify for CANHR's Elder Law Panel Membership:
  1. I am not licensed to sell insurance products.
  2. I have not been disciplined by the state bar.
  3. I am continuously covered by a policy of errors and omissions insurance of at least $100,000 for a single occurrence & $300,000 aggregate per year.
Please continue with the form below if the above statements do not apply to you.


Title: Bar #:
Your Name:


  State: Zip:
Email Address:


  I am requesting the following applications:

    Estate Planning for Long Term Care Panel
EADACPA and Elder Abuse Specialization Panel
Conservatorship Panel
Elder Fiduciary Abuse Panel Application
Special Needs Trust Panel
Patients' Rights Panel Application