Please submit the following information so that we may:
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Approve you as an authorized Retirement Lesson Plan advisor.
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Include you in our searchable advisor directory so that teachers and others can easily find you.
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Create a profile page all about you, where teachers can contact you directly.
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| First Name |
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| Last Name |
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| E-mail Address |
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| Phone # |
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| Company |
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| Photo |
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Photo should be a professional headshot less than 1MB
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| Logo of your primary 403(b) company |
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Primary Logo is vendor logo (e.g. Security Benefits, MetLife, AXA, etc.)
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| Your DBA logo |
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Secondary Logo is independent advisor logo (e.g. One2One Wealth Strategies, Graystone Partners, etc.). We realize you may only have a primary logo.
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| Broker/Dealer disclosure statement |
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| Self-enrollment data: |
| District |
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| URL |
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URL:
Link text:
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| Rep # |
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| Plan # |
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| Intro video (URL) |
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URL:
Link text:
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| Do you offer variable annuities and or mutual funds? |
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| Do you offer fixed insurance products? |
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| Bio (< 1000 words) |
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| Please select only the districts where you have a relationship. Be sure that you have the Regional Manager (or company) approval to represent their product in all districts for which you are requesting approval. “Flooding” districts with requests to be added, or not having company approval to represent a specific product, may result in your being barred from the site. The site administrator will monitor activity to prevent these abuses. |
| Districts -- select all that apply (to select multiple districts within a county, press the <ctrl> key) |
| Apache County |
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| Cochise County |
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| Coconino County |
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| Gila County |
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| Graham County |
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| Greenlee County |
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| La Paz County |
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| Maricopa County |
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| Mohave County |
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| Navajo County |
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| Pima County |
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| Pinal County |
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| Santa Cruz County |
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| Yavapai County |
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| Yuma County |
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| Select the two primary counties where your work is concentrated: |
| What is the 1st county in which you work? |
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Use the control key to select more than one
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| What is the 2nd county in which you work? |
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Use the control key to select more than one
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| For all districts that have posted a Code of Conduct on their page, please confirm that you have read and agree to comply with all conditions, including any security / fingerprinting requirements for the districts you can provide service. |
| Do you agree? |
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