Distributors Application Form

Please complete the below to be considered for a Distributor focused Protectors Pass









    Which of the following best describes your role in the industry? (Please choose one) *


    Individual Agent Details




    Approximate premium volume last year *

    Agency Owner / Principal Details




    Approximate agency premium volume last year *

    Independent Advisor Details




    Approximate AUM *

    RIA Owner / Principal Details




    Approximate Firm AUM *

    Bank / Wirehouse Advisor Details



    Approximate production last year *

    Broker-Dealer Rep Details



    Approximate annual GDC *

    Organization Leadership Details




    IMO / FMO Marketer Details


    Bank / Wirehouse Insurance Desk Details


    Wholesaler Details




    Are you interested in also applying for Travel Reimbursement (up to $1,000)? *

    The amount of travel reimbursement is determined by Protectors and based on potential fit with our sponsors. Those with larger books of business and/or those who our sponsors will hope to meet will qualify for larger reimbursement amounts. More information can be found on the FAQ section of the Protectors Pass Page.

    What would you most like to accomplish in the next 12–18 months? *

    What topics are most relevant to you? (Select all that apply)


    I understand that participation will require attendance at sponsored sessions, sponsored roundtables, and/or visiting with select sponsors. *