Young Agents Membership Registration

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* 1. Please complete the following information for the YAC membership application...

First Name:

Last Name:

Company Name:

Your Title:

Email Address:

Cell phone number:

Office phone number:

City in which you work:

Date of Birth (mm/dd/yr):

License #:

Year first licensed:

Facebook Profile:

Twitter Profile:

Company/Agency FB Page:

LinkedIn Profile:

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* 2. How often do you attend Young Agents events?

Extremely often

Very often

Moderately often

Slightly often

Not at all often

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* 3. If you do not attend YAC events, then why?

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* 4. What is your role within your agency/company?

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* 5. What types of activities would you participate in if they were available for you to do so?
(Choose all that apply)

YAC Social Mixers in your town

YAC Political Action Committee meetings

YAC networking events

GA InVest (Volunteering to teach a class)

Collegiate Career Day events

Leadership development training

Sales/Producer courses

AAI designation courses

Agency perpetuation training

Social Media/Digital Marketing training

Other (please specify)

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* 6. Do you hold any designations?

NONE

ARM

AAI

ACSR

CIC

Other (please specify)

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* 7. Which Social Media sites do you use for Business?

NONE

Facebook

Twitter

Other (please specify)

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* 8. Are you currently subscribed to the YAC text notification system?

YES

If you would like to be subscribed, please type your cell number below (Ex: 555-555-5555).

Question Title

* 1. Please complete the following information for the YAC membership application...

Question Title

* 2. How often do you attend Young Agents events?

Question Title

* 3. If you do not attend YAC events, then why?

Question Title

* 4. What is your role within your agency/company?

Question Title

* 5. What types of activities would you participate in if they were available for you to do so? (Choose all that apply)

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* 6. Do you hold any designations?

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* 7. Which Social Media sites do you use for Business?

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* 8. Are you currently subscribed to the YAC text notification system?

* 5. What types of activities would you participate in if they were available for you to do so?
(Choose all that apply)