GENERAL INFORMATION

This survey must be completed and submitted by June 25, 2019.
Asterisked questions require responses.

Please complete item #1 to proceed with the report.

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* 1. Firm Name:

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* 2. Headquarters Business Address:

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* 3. List All Other Branch and Subsidiary Offices:

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* 4. Firm Website Address:

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* 5. Is your website available in English?

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* 6. WBN Owner(s), Title(s) and Contact Details (Phone #, Email and Address):

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* 7. Billing Contact Details for the Annual Membership Dues Invoice (Name, Title, Phone #, Email and Address):

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* 8. Property & Casualty International Desk Contact, Title and Email Address:

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* 9. Employee Benefits International Desk Contact, Title and Email Address:

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