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.    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