Senior Market Advisor Advisory Board Application Survey

Are you ready to voice your opinion and bring your business to another level by discussing and sharing your ideas, strategies and success techniques?

Become part of the Advisory Board and enjoy:

-VIP Status and discounts to the industry's leading event, Senior Market Advisor Expo

-Industry-wide recognition when your ideas, opinions, insights and success techniques are published in Senior Market Advisor.

-Exclusive first looks at new industry data, contests and awards

- AND MUCH MORE!

Complete the questions below outlining your experience, product suite, and production information to apply for the Advisory Board.

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1. Are you involved in using, recommending, advising or specifying the following products or services? (check all that apply)

Are you involved in using, recommending, advising or specifying the following products or services? (check all that apply) 401(k) & retirement products

529 plans

Banking/lending

Disability insurance

Estate planning

EIAs

ETFs

Final expense insurance

Fixed annuities

Health insurance

Hedge funds

Individual securities

Life settlements

Long term care insurance

Medicare supplements

Mutual funds

Private equity

REITs

Reverse mortgages

Separately managed accounts

Term life insurance

Trust services

Universal life insurance

Variable annuities

Whole life insurance

Wrap accounts

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2. What is your age?

What is your age? under 25

25 - 34

35 - 44

45 - 54

55 - 64

65 or over

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3. Are you...?

Are you...? Captive

Semi-captive

Career agent

Independent

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4. What is the average age of your clients?

What is the average age of your clients? under 50

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 or over

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5. Are you self-employed?

Are you self-employed? Yes

No

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6. Including yourself, how many agents are employed by your organization?

Including yourself, how many agents are employed by your organization? 1

2

3 - 5

6 - 10

11 - 24

25 - 49

50 - 74

75 - 99

100 or more

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7. How many clients do you currently serve?

How many clients do you currently serve? 1 - 9

10 - 19

20 - 49

50 - 99

Over 100

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8. Other than the senior market, what other markets do you serve? (Choose all that apply.)

Other than the senior market, what other markets do you serve? (Choose all that apply.) Affluent market

Baby boomer market

College funding market

Family market

Group/voluntary benefits market

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9. Please check the following designations/licenses you currently hold or are planning on receiving in the future. (check all that apply)

	Currently Hold	Planning to Receive
Life/health	Please check the following designations/licenses you currently hold or are planning on receiving in the future. (check all that apply) Life/health Currently Hold	Planning to Receive
CASL	CASL Currently Hold	Planning to Receive
CSA	CSA Currently Hold	Planning to Receive
CLU	CLU Currently Hold	Planning to Receive
ChFC	ChFC Currently Hold	Planning to Receive
CEP	CEP Currently Hold	Planning to Receive
CFP	CFP Currently Hold	Planning to Receive
CLTC	CLTC Currently Hold	Planning to Receive
CPCU	CPCU Currently Hold	Planning to Receive
CPA	CPA Currently Hold	Planning to Receive
LTCP	LTCP Currently Hold	Planning to Receive
RHU	RHU Currently Hold	Planning to Receive
RIA	RIA Currently Hold	Planning to Receive
Series 6	Series 6 Currently Hold	Planning to Receive
Series 65	Series 65 Currently Hold	Planning to Receive
Series 7	Series 7 Currently Hold	Planning to Receive
None of the above	None of the above Currently Hold	Planning to Receive

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10. Over a typical 12-month period, how many dollars do you sell for the following annuity products?

	Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
Fixed annuities	Over a typical 12-month period, how many dollars do you sell for the following annuity products? Fixed annuities Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
EIAs	EIAs Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
Variable annuities	Variable annuities Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell

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11. Over a typical 12-month period, how many dollars do you sell for the following life insurance products?

	Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
Whole life insurance	Over a typical 12-month period, how many dollars do you sell for the following life insurance products? Whole life insurance Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
Term life insurance	Term life insurance Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell
Universal life insurance	Universal life insurance Less than $100,000	$100,000 - $299,999	$300,000 - $499,999	$500,000 - $999,999	$1,000,000 or more	Do not sell

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12. Over a typical 12-month period, how many dollars do you sell in long term care insurance?

Over a typical 12-month period, how many dollars do you sell in long term care insurance? Less than $100,000

$100,000 - $249,999

$300,000 - $499,999

$500,000 - $999,999

$1,000,000 or more

Do not sell

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13. Please indicate your annual income:

Please indicate your annual income: Less than $50,000

$50,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

Over $200,000

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14. Please provide your contact information below.

Please provide your contact information below. Full Name:
Company:
Address:
Address 2:
City:
State:
ZIP:
Email Address:
Phone Number:

1. ABOUT YOU