Guardianship Association of NJ, Inc.             

P.O. Box 546, Chester, New Jersey 07930   www.ganji.org

Phone:  973-927-5714     Fax:  973-584-1887     Toll Free:  877-GUARDNJ

 

Membership Form

Application:             Initial___________ Renewal___________

Please return membership application with check to:        GANJI

            PO Box 546

            Chester, NJ 07930

 

Name

 

Professional Category

 

Title

 

Company/Agency

 

Address

 

City/State/Zip

 

Phone

 

Fax

 

Email Address

 

Website Address

 

Include in Member Listing

    _____ Yes      _____ No

 

*Pick one from the following professional categories:

1.    Elder Law Attorney

2.    Geriatric Care Manager

3.    Fiduciary

4.    NJ Licensed Psychologist.

5.    Insurance and Financial Services

6.    NGF Registered or Master Guardian

7.    Physician

8.    Other 

 

Type of Membership (Agency/Organization/Type)

Individual        ($ 40)   Note 1

 

Public

 

Private

 

Professional    ($75)   Note 2

 

Not-for-Profit

 

For Profit

 

Organization   ($140)  Note 2

 

Volunteer

 

Corporation

 

 

Note 1:   Initial year dues are waived for a family member who becomes a court-appointed guardian of another family member.

Note 2:   Include additional $25 for professional listing on our website.

 

 

 

Member Information (optional):

I serve the following population(s) (check all that apply):

Senior Citizens

 

Mentally Ill

 

Mentally Impaired

 

Developmentally Disabled

 

Physically Disabled

 

Traumatic Brain Injury

 

Court-Related

 

Other:

 

 I offer the following services or provide care (check all that apply):

Guardianship

 

Health Care Proxy

 

Rep Payee

 

Legal

 

Care Management

 

Psychological Assessment and/or Treatment

 

Fiduciary/Trust

 

Home Health

 

Other:

 

 

I would like to serve on a GANJI Committee:

Advocacy

Newsletter

Conference

Membership

Ethical Standards

Publicity

Education

Strategic Planning

Grants/Development

Technology