ࡱ> uwt@ Ibjbj buuGr~~~~( 8 L!(FF~!H"($#$#$#6&&L$'(EEEEEEE$HRKEE+%^6&++E~~$#$#Fu.u.u.+v~R$#$#Eu.+Eu.u.E@"A$#! PEn& M,R@BF0FF@K,K(A~~~~KAL'j(u.6))L'L'L'EE((_.(( STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS CONSUMER CREDIT COUNSELING ROUNDTABLE APPLICATION S.C. Code Ann. 37-7-105(C)(2)  HYPERLINK "http://www.state.sc.us/consumer" www.scconsumer.gov 803-734-4236/800-922-1594 Recognizing the need for communication between regulators and licensees, the Department is establishing a Consumer Credit Counseling Roundtable. The Roundtable will: meet on a quarterly basis at the Department of Consumer Affairs; discuss hot topics and other issues in the industries covered under the Consumer Credit Counseling Act; overall aid the Department in maintaining a communicative relationship with these industries. We would like to form a diverse Roundtable compiled of individuals from the credit counseling, credit repair, and debt negotiation industries for profit and not for profit. If you are interested, please fill out this form and return it to the following address: South Carolina Department of Consumer Affairs Attn: Carri Grube P.O. Box 5757 Columbia, SC 29250 Applicant s Name: FORMTEXT      Full Name of Organization: FORMTEXT      Applicant s Position: FORMTEXT      Mailing Address: FORMTEXT      City/State/Zip FORMTEXT      Telephone No.Fax No.( FORMTEXT    )  FORMTEXT     -  FORMTEXT     ( FORMTEXT    )  FORMTEXT     -  FORMTEXT     E-Mail Address: FORMTEXT      Organization s Current Business Type: FORMCHECKBOX Non-Profit FORMCHECKBOX F9UWbmn|ɹq^L=L#2jh`Z"hz0J56CJOJQJU\aJh5CJOJQJ]aJ"h<h<5CJOJQJ]aJ%ho-h<5>*CJOJQJ]aJhzB*CJOJQJaJphhS/B*CJOJQJaJphhB*CJOJQJaJph.jho-ho-5>*CJOJQJU]aJho-B*CJOJQJaJphhhzCJOJQJaJh-hzCJOJQJaJ0jh-hzCJOJQJUaJmHnHu 9Un @ `'L`'L`'V`'V`'V`'V`'V`'`'{`'{`'{`'{`'{`'{`'{`'{`'{`'{`'{`gd & FgdgdgdS/ %d O gd< %d O gdz %d O gdHHI  ҸꕀiZHZHZH5%hh5CJOJQJ\]aJ"hhCJOJQJ\]aJhCJOJQJ\]aJ,h-h<0J56:CJOJQJ\aJ)hz0J56:;CJOJQJ\aJ)ho-0J56:;CJOJQJ\aJh10JCJOJQJaJ2jh`Z"hz0J56CJOJQJU\aJ.jh`Z"hzCJOJQJU]aJ)h`Z"hz0J56CJOJQJ\aJ   : < > @ h `'{`'{`'{`'{`'{ z $Ifgd} $IfgdOkd$$Ifl40 '` 4 laf4 $IfgdE- $Ifgd(%gd- $`a$gd   @ B V X Z d f      & ( * T V ŲzŲ_zŲŲDzŲ4jIhnh(%B*CJOJQJUaJph4jhnh(%B*CJOJQJUaJph9jhnh(%B*CJOJQJUaJmHnHphu4j[hnh(%B*CJOJQJUaJph%hnh(%B*CJOJQJaJph.jhnh(%B*CJOJQJUaJphhnh(%CJOJQJaJ%h(%h-5CJOJQJ\]aJh j  V OkdM$$Ifl40 '` 4 laf4 $IfgdOkd$$Ifl40 '  4 laf4  * D V Okd$$Ifl4q0 '` 4 laf4 $IfgdOkdE$$Ifl40 '  4 laf4* , N P R T |   MD;  $Ifgd} $IfgdE-Okd5$$Ifl4q0 '` 4 laf4 $Ifgd $Ifgd(%Okd$$Ifl4p0 '  4 laf4V j l n x z  &(,ѹzdzKzz5zKz+jO hnh(%CJOJQJUaJ0jhnh(%CJOJQJUaJmHnHu+jhnh(%CJOJQJUaJ%jhnh(%CJOJQJUaJhnh(%CJOJQJaJ9jhnh(%B*CJOJQJUaJmHnHphu.jhnh(%B*CJOJQJUaJph4jhnh(%B*CJOJQJUaJph%hnh(%B*CJOJQJaJph| ~   M Okd$$Ifl4q0 '` 4 laf4 $Ifgd $Ifgd(%Okd!$$Ifl4p0 '  4 laf4    -6 $Ifgd $Ifgd(%Okd$$Ifl4p0 '  4 laf4z|~D;2 (22 $Ifgd $Ifgd(%kd$$Ifl4qֈ '`  ```4 laf4p<,.BDFLNTVjlnvxݘ݂lV+j hnh(%CJOJQJUaJ+j hnh(%CJOJQJUaJ+j hnh(%CJOJQJUaJ+j/ hnh(%CJOJQJUaJ0jhnh(%CJOJQJUaJmHnHu+j hnh(%CJOJQJUaJhnh(%CJOJQJaJ%jhnh(%CJOJQJUaJ!~(2')  $Ifgd(%kd $$Ifl4pֈ '      4 laf4p< $Ifgd} $IfgdE-"$8:<FH8 888ŲzdNL=hnhCJOJQJaJU+jhnh(%CJOJQJUaJ+jThnh(%CJOJQJUaJ9jhnh(%B*CJOJQJUaJmHnHphu4j hnh(%B*CJOJQJUaJph%hnh(%B*CJOJQJaJph.jhnh(%B*CJOJQJUaJphhnh(%CJOJQJaJ%jhnh(%CJOJQJUaJ "JLNwn  $Ifgd}ukd? $$Ifl4q\ '` ``4 laf4 $IfgdE- $IfgdNPRT `'ED9DL $$Ifa$gd8:kd$$Ifl4'8(4 laf4 $IfgdukdS$$Ifl4p\ '    4 laf4 8 8 8 888888cW2WXh  $$Ifa$gdc31kd<$$Ifl4rX '$ ht4 laf4 $Ifgd $$Ifa$gd8 or Profit FORMCHECKBOX Sole Proprietorship FORMCHECKBOX Partnership FORMCHECKBOX Limited Liability Company FORMCHECKBOX CorporationPlease give a brief statement of why you should be chosen for the Roundtable. FORMTEXT 888&8:86*2 $$Ifa$gdc31kd$$Ifl4ִhr  HX ' 0h@ ht    4 laf4 $Ifgd8#8$8%8:8;8I8J8K8X8Y8g8h8i888888888889wlYJhnhCJOJQJaJ%jhnhCJOJQJUaJhh(%OJQJhhCJOJQJaJ+j(hnh(%CJOJQJUaJ+jhnh(%CJOJQJUaJ+j@hnh(%CJOJQJUaJ%jhnh(%CJOJQJUaJ+jhnh(%CJOJQJUaJhnh(%CJOJQJaJ:8L8X8j8888Xh  $Ifgd $$Ifa$gdc3188888?3*23 $Ifgd $$Ifa$gdc31kd$$Ifl4ִhr  HX ' 0h@ ht    4 laf48888888Xh 6kd$$Ifl4ִhr  HX ' 0h@ ht    4 laf4 $Ifgd888HHH@HXHHHHHH`'`'~y`'t`'it`'io`'immhVhVgdzgd;gdj|gdS/<kd5$$Ifl4'8(4 laf4:kdp$$Ifl4'8(4 laf4 $Ifgd 99:H H HHH(H>H@HLHTHVHXHbHdHpHԻ֬{oo`Q>Q%jhnhnCJ OJQJUaJ hnhnCJ OJQJaJ h9hS/CJ OJQJaJ hS/CJ OJQJaJ h(PhS/CJ OJQJaJ hnCJ OJQJaJ hoCJ OJQJaJ hS/CJOJQJhnhCJOJQJaJ0jhnhCJOJQJUaJmHnHuU%jhnhCJOJQJUaJ+jhnhCJOJQJUaJ      Roundtable Application Rev. 01/06 Page  PAGE 1 of  NUMPAGES 1 Mailing Address P.O. 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