Senior Market Advisor Free Subscription

	*Senior Market Advisor* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Senior Market Advisor*, please answer ALL of the questions on the form below.
	The magazine 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 Senior Market Advisor?*

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Which of the following best describes your industry? (select only one)

Please specify for Other:

Which of the following is closest to your job function? (select only one)

Please specify for Other:

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

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

2.	I currently/plan to target the Senior Market:

Yes No

3.	The markets I currently/plan to target include:

Current Plan

Affluent Market

Baby Boomer Market

College Funding Market

Family Market

Group/Voluntary Benefits Market

4.	I am a licensed Life/Health Agent:

Yes No

5.	I am involved in selling the following: (select all that apply)

Annuities Life Insurance

Equity Index Annuities Accelerated Death Benefit

Immediate Annuities Annuity Take Over

Multi-Year Guarantee Annuities First to Die

Structured Settlements Final Expense

Traditional Fixed Annuities Guaranteed Issue

Tax Sheltered Annuities Impaired Risk

Variable Annuities No Load Insurance

Charitable Gift Annuities Second to Die

Long Term Care & Medicare/Other Single Premium Life Insurance

Individual LTC Term Insurance

Group LTC Universal Life

Substandard LTC Whole Life

Tax Qualified LTC Variable Life

Medicare Supplements Securities

Critical Illness Insurance Bonds

Disability Insurance Limited Partnership

Group Disability Insurance Mutual Funds

Individual Disability Insurance Stocks

Life Settlements Variable Annuities

Investments Variable Universal Life

Life Insurance Buying Retirement Savings

Viaticals IRA/IRA Rollover

401(k)

None of the above products

6.	My Income is: (select only one)

Under $55,000 $200,000 - $300,000

$55,000 - $99,999 Over $300,000

$100,000 - $199,999

7.	Number of agents in my organization: (select only one)

Under 10 50-100

10-49 Over 100

8.	I have been involved in selling: (select one for each column)

Insurance Securities

Under 3 Years

3 - 10 Years

11 - 20 Years

Over 20 Years

Not involved in selling

9.	I am: (select only one)

Independent Semi-Captive Captive

10.

I am a member of: (select all that apply)

FPA NAELA

LUTCF NAPFA

MDRT SSMP

NAHU SFSP

NAILBA None of the above

NAIFA

11.

Licenses & Designations (currently hold, or working towards): (select all that apply)

CSA CPA

CLU RIA

ChFC Series 6

CEP Series 7

CFP CLTC

RHU LTCP

CPCU None of the above

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