Life & Annuity Registration FormOmaha, NebraskaSeptember 25-27, 2024 Name as it appears on government-issued photo ID:*Do you prefer a different name to appear on your name badge? Yes No - Use the name on my ID First name on name badge:Last name on name badge:Date of Birth:* MM slash DD slash YYYY Gender:* Male Female Best contact phone number during travel:*Email:* Flying or Driving?*SelectFlyingDrivingAirport Departure City:Airline Seat Preference:Frequent Flyer # and Airline:TSA/Global Entry #:Emergency Contact Name:*Emergency Contact Phone Number:*List your traveling companions if applicable:Will you require a hotel? Yes No Dietary Requirements:Special Requests:Shirt Size:*Please ChooseWomen's SmallWomen's MediumWomen's LargeMen's SmallMen's MediumMen's LargeXL2XL3XLWhat percentage of your business is in the following categories:Life:*Please enter a number from 0 to 100.Annuity:*Please enter a number from 0 to 100.Med Supp/Advantage:*Please enter a number from 0 to 100.Securities/AUM:*Please enter a number from 0 to 100.LTC:*Please enter a number from 0 to 100.Other:*Please enter a number from 0 to 100.If you are mainly an annuity producer, what percentage of your annuity business is:Fixed:*Please enter a number from 0 to 100.Indexed:*Please enter a number from 0 to 100.Variable:*Please enter a number from 0 to 100.If you are mainly a life producer, what percentage of your life business is:Universal Life - Traditional:*Please enter a number from 0 to 100.Indexed Universal Life:*Please enter a number from 0 to 100.Variable Universal Life:*Please enter a number from 0 to 100.Single Premium Life - Wealth Transfer:*Please enter a number from 0 to 100.Whole Life:*Please enter a number from 0 to 100.Term:*Please enter a number from 0 to 100.Do you perform annual reviews?*SelectYesNoWould you like help in making reviews profitable?*SelectYesNoDo you plan on taking the Series 65 test in the next year?*SelectYesNoAre you doing any client appreciation events?*SelectYesNoHow would you describe your main market?*SelectSenior MarketBusiness MarketEstate PlanningHealth MarketFamilyMoney ManagementOtherWhat additional products or concepts are you looking to incorporate into your practice?*How much volume do you expect to write in 2024?Life:*Annuity:*Securities/AUM:*List your top two go-to life companies.1.*2.*List your top two go-to annuity companies.1.*2.*Securities License and/or designations held:*Broker-dealer/RIA affiliation:*Are you currently using a lead system? If so, what type?* Seminars & Meals Direct Mail Internet Marketing Online Leads Telemarketing Purchased Lists Other Are you currently using any social networking outlets? If so, what outlet(s)?* Facebook LinkedIn Twitter Blog Other Do you have a website?*SelectYesNoDo you have a recognizable brand?*SelectYesNoHave you utilized search engine or email marketing?*SelectYesNoDo you use a CRM?*SelectYesNoWould you like a headshot or video?* Headshot Short Video Headshot & Short Video Not Interested Unsure, reach out to me later and ask me During your time at our academy, our creative team offers professional headshots and video services. If you’re interested, you will be pulled out during one of the presentations, but don’t worry—if you don't want to miss a particular presentation, we can catch you at another time. You can download these photos and videos via a link provided after the academy. Additionally, we will store these images on our server for any future marketing purposes you may have. More Details Δ
