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Name:
(Required)
First
Last
Please confirm the agent's name.
Email:
(Required)
Please confirm the agent's email address
Phone Number:
(Required)
Please confirm the agent's phone number.
Company Name:
(Required)
Please confirm your company name.
Website address (URL):
Confirm Event Type and Price
Safe Money Event Type
Safe Money Event Price Selected
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Price:
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Lead Management
Do you want lead notifications to be sent to any additional email addresses?
(Required)
Yes
No
By default, your leads are sent to your email address.
Additional Email Address
(Required)
Enter in the additional email address(es) you would like leads sent to. Please separate multiple email addresses with a comma.
We are interested in using the Safe Money Events Confirmation Call Setter.
(Required)
No
Yes (Additional $500)
Event Information
How many dates are you registering for?
(Required)
One Date
Two Dates
Choose your event topic
(Required)
Retirement Income Planning
Social Security
Taxes & Retirement
Alternate Topic
Estate Planning for Everyone/LegacyLock
If you choose an alternate topic, it will not be guaranteed.
Please enter your alternate topic
(Required)
Please note: Alternate topics are not guaranteed per our best practices.
First Date Details
First Date:
(Required)
MM slash DD slash YYYY
Event Start Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Event End Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Name of the Venue
(Required)
It's important to select the right venue for your campaign. We suggest reviewing our best practices to make sure your event is successful.
Venue Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please provide any specific directions if necessary.
Examples: parking, buildings, rooms, etc.
What is the total number of people the venue can hold?
(Required)
What is the set menu for your dinner seminar?
The menu is one of the most important factors in the success of your event. Be as specific as possible to ensure that you have something for everyone. Having a steak option is always a good idea to help drive up attendance.
Do you have any additional notes?
Make sure to add any special notes or comments you have for this event.
Second Date Details
Second Date:
(Required)
MM slash DD slash YYYY
Second Date Start Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Second Date End Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Do you have any additional notes?
Make sure to add any special notes or comments you have for this event.
Presenter Information
Presenter's Name
(Required)
First
Last
Please provide a company or personal biography for the presenter.
(Required)
You can also provide a link to the bio if you prefer.
What is the presenter's state license number?
If applicable.
Is the presenter a registered rep?
(Required)
Yes
No
Please write out any disclosures we will need to include.
(Required)
We will need these every time you fill out a questionnaire to make sure your campaign is not delayed.
Please upload a photo/headshot of the first presenter.
Max. file size: 2 GB.
Please upload your company logo
Max. file size: 2 GB.
Submission Review
{all_fields:nohidden}
Terms and conditions apply for guaranteed reimbursements:
View our Best Practices/Terms and Conditions
HERE.
Terms & Conditions
(Required)
I agree to the terms and conditions
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