MDRT Topic Submission Form for 2013 ConneXion Zone Survey

* this is a required field

The ConneXion Zone is THE place to go to interact with exhibitors, experience hands-on learning using the latest tools, and share useful business information with your fellow MDRT members. Please fill out the information below about TOPICS you would like to hear about in the ConneXion Zone at the 2013 MDRT Annual Meeting in Philadelphia. The recommendation form must be submitted by NOVEMBER 16, 2012.

1.What TOPICS would you like to hear about in the ConneXion Zone? Please be as specific as possible. For example, "401K Roth plans for small companies" would be a more specific topic than "small company retirement plans".

Topic 1

Topic 2

Topic 3

Topic 4

2.Please list YOUR contact information so that we might contact you if we need clarification (*all fields are required):

*Last/Family Name

*First Name

*E-mail

*MDRT Member ID

3.This topic will appeal to:

Primarily U.S.-based audience

Global Audience

Other (please specify)

4.Should the session be presented in a language other than English?

Yes

If yes, please specify language

If you have any recommendations for great SPEAKERS for the 2013 ConneXion Zone at the MDRT Annual Meeting in Philadelphia, please fill out the the SPEAKER RECOMMENDATION form on the MDRT website.

Thank you for taking the time to submit this CONNEXION ZONE topic recommendation. Million Dollar Round Table 325 W. Touhy Ave. Park Ridge, IL 60068 +1 847.692.6378 www.mdrt.org