Healthcare Benefit Survey Question Title * 1. I certify that I am a person that plant or causes to be planted, a soybean crop in ND in which I have an ownership interest, with intent that upon maturity, the crop will be harvested; or I will have met the requirements of the above stated during the next available growing season if I have not met these requirements during the preceding growing season. Yes No Question Title * 2. Please complete this section. Name: Zip code: Question Title * 3. What is your age? Question Title * 4. What is your gender? Male Female Question Title * 5. How many people would you like to insure? Single Plan Family Single plus one Question Title * 6. Who is your current insurance provider? Question Title * 7. What type of plan did you have? Group Individual Done
