Life Insurance Selling Free Subscription

	*Life Insurance Selling* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Life Insurance Selling*, please answer ALL of the questions on the form below.
	The publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: USA

1.	*Do you wish to receive a FREE subscription to Life Insurance Selling?*

Yes No

First Name:
Last Name:
Job Title:
	(Ex: Director, Vice President, Project Manager, etc.)
Company Name:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Address 1:
Address 2:
City:
State:
Zip:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Business Phone:
Fax:
Email:
	(Note: Valid email address is required or you could be disqualified.)

I do not wish to receive relevant third party offers and/or special promotions.

Yes, please auto-fill my contact information for other publication qualification forms.

What is the approximate number of employees in your company? (select only one)

2.	Which professional designations do you hold? (select all that apply)

CLU CLTC

ChFC CEBS

CFP CSA

RHU LTCP

None

3.	Which of the below is your primary profession? (select only one)

Producer with Financial Planning focus Life General Agent or Manager

Producer with Life/Health focus Insurance Company Personnel

Producer with Property/Casualty focus Other (please specify)

4.	Do you sell: (select all that apply)

Universal Life Mutual Funds, Bonds or other Kinds of Securities

Term Insurance Fixed Annuities

Disability Insurance Variable Annuities

Individual Health Variable Life or Variable Universal Life

Group Health Payroll Deduction or Work-Site Mktg. Prods.

Long-Term Care Other (please specify)

5.	Do you work in the following markets? (select all that apply)

Estate Planning Senior Market

Employee Benefits Other (please specify)

Business Insurance

6.	Last year, what was the amount of your paid personal life production (face amount)? (select only one)

10 Million or more $2 - $2.9 Million

$5 - $9.9 Million $1 - $1.9 Million

$4 - $4.9 Million $500,000 - $999,999

$3 - $3.9 Million $Less than $500,000

7.	In lieu of a signature, we require a personal identifying question. What is the day of the month you were born?

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

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* The publisher reserves the right to limit the number of free subscriptions and/or reject requests based on information provided.