Campaign Questionnaire Let’s Get Started For us to get started on building out your next Retire for LIFE course campaign, we ask you fill out this short registration form. Step 1 of 12 8% Event Remaining BalanceName:* First Last Please confirm the advisor's name.What is your preferred title?*i.e. President & FounderWhat credentials, if any, would you like listed?i.e. CFP®, ChFC®, CLU®, CTS™, CEP®, RFC®, etc. Email:* Please confirm the advisor's email address. This will be the email address we use for consumer facing advertisements.Phone Number:*Please confirm the advisor's phone number. This will be the phone number we use for consumer facing advertisements.Company Name:*Please confirm the advisor's company name.Website address (URL):*Webinar Packages Gold - $1,999 Platinum - $2,999 Your Federal Retirement Webinar Packages Gold - $2,999 Platinum - $3,999 Please choose your Webinar Package* Gold Platinum Please choose your event type.* Dinner Seminar Workshop Please choose your event package.* Silver Gold Platinum Please choose your event package.* Silver Gold Platinum Please choose your event type.* Dinner Seminar Workshop Please choose your Elite Series Package.* Starter Pro Ultimate Lead Management InformationDo you want lead notifications to be sent to any other email addresses?* Yes No By default, your leads are sent to your email address.Additional Email Address*Enter in the other email address(es) you would like leads sent to. Please separate multiple email addresses with a comma.Will you be the main point of contact for our confirmation calling team?* Yes No You will receive an introductory call and be in direct communication with this team. *If you would rather have another member of your team be the main point of contact, please select “No” and then provide their contact information. Please provide the main point of contact's information.*Please include name, email address and phone number. Topic InformationChoose your event topic* Retirement Income Planning Social Security Taxes & Retirement Women & Wealth Social Security & Taxes Estate Planning (Attorney co-presenter required) Federal Employees Medicare Alternate Topic If you choose an alternate topic, it will not be guaranteed.Choose your event topic* Rising Tax Risk in Retirement Legislative Risk Please select which Stonewood book you are offering.* No-Compromise Retirement Plan New Holistic Retirement No book is being offered. Please provide the title of your custom topic.*Please note: Custom topics are not guaranteed per our best practices.Please provide a summary with bullet points on what is going to be covered with this topic.*If you have a presentation for this topic, please upload it here.Max. file size: 8 MB. Event InformationHow many dates are you registering for?* One Date Two Dates Three Dates For in-person events, if the venue can only hold a limited number of people and/or you are opting for a smaller seminar package, we highly recommend offering no more than two dates. We do not recommend hosting three dates for in-person events. Please consult your Marketing Account Manager before submitting the questionnaire if you have questions regarding your seminar plan.Please enter the target geographic area for your webinar campaign.*i.e. a certain county, multiple counties, radius around a city, etc. In your opinion, how long of a commute time / distance would a prospect be willing to travel for this event? Are there any geographical areas that need to be excluded from our targeting?*If applicable, please enter any specific federal departments you would like to target.If you have any of the following special requirements, please include that information below. Need to include mailing address in registration form. Need to include meal choices for dinner seminars in registration form. Custom registration fields need to be included in form. Venue headcounts required by a certain date. Any other special requirement for your event. Do you have any special notes for your campaign?Make sure to add any comments you have for this event. Retire For L.I.F.E Event InformationSelect One if your event follows this format: One single-day event One two-day event Select Two if your event follows this format: Two single-day events Two two-day eventsHow many sessions are you registering for?* One Two Please reference above.Will your session take place over one day or two days?* One Two Will your sessions take place over one day or two days?* One Two 1 One-Day Session, 1 Two-Day Session Which mailhouse do you want to use for your mailers?* LeadJig FSS MBI Other Not Sure Select "Not Sure" if you want more information on the options available with our different mailhouse partners.What is the name of the mailhouse you will be using?*No worries! We can help you decide which mailhouse would be the best fit for your market! We'll be in touch to discuss the details and options available to you.Session 1 First Date* MM slash DD slash YYYY Event Start Time (Session 1 First Date)* : Hours Minutes AM PM AM/PM Event End Time (Session 1 First Date)* : Hours Minutes AM PM AM/PM Session 1 Second Date* MM slash DD slash YYYY Event Start Time (Session 1 Second Date)* : Hours Minutes AM PM AM/PM Event End Time (Session 1 Second Date)* : Hours Minutes AM PM AM/PM Session 2 First Date* MM slash DD slash YYYY Event Start Time (Session 2 First Date)* : Hours Minutes AM PM AM/PM Event End Time (Session 2 First Date)* : Hours Minutes AM PM AM/PM Session 2 Second Date* MM slash DD slash YYYY Event Start Time (Session 2 Second Date)* : Hours Minutes AM PM AM/PM Event End Time (Session 2 Second Date)* : Hours Minutes AM PM AM/PM Will you be charging a fee to attend your course?* Yes No We do not recommend charging for these events. Please ensure you discuss this with your client success manager if you are wanting to proceed with charging for this event.For registrants paying by check, whom should checks be made payable?*Would you like us to do confirmation calls?* Yes No Free courses will have a larger volume of registrations, so we are including confirmation calls at no additional charge. If you want to do the confirmation calls yourself, please select No. If yes, our confirmation team will reach out to you before your event for additional details.Where are you hosting these events?*Please ensure you have reserved the necessary meeting space prior to submitting this questionnaire.Venue Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide any specific arrival and meeting room instructions.*This includes parking information, building name, room number, map, etc. It is very important that we can make it as easy as possible for the consumer to feel confident in attending. Webinar InformationFirst Date:* MM slash DD slash YYYY First Date Start Time* : Hours Minutes AM PM AM/PM First Date End Time* : Hours Minutes AM PM AM/PM Second Date:* MM slash DD slash YYYY Second Date Start Time* : Hours Minutes AM PM AM/PM Second Date End Time* : Hours Minutes AM PM AM/PM Third Date:* MM slash DD slash YYYY Third Date Start Time* : Hours Minutes AM PM AM/PM Third Date End Time* : Hours Minutes AM PM AM/PM Please select any interactive features you want included with your webinar event.* Poll Questions Handouts Pop-Up Offers (e.g. Schedule an Appointment) I do not want any interactive features. Please provide the interactive content you want included.*Poll questions with applicable answers. Handout specifications. Specific pop-up offer. If applicable, please state any value-add offerings you are providing to those who schedule an appointment.ie. Free Retirement Analysis, Social Security & Tax Analysis, Retirement Road Map, Free Book, Risk Assessment, etc.Please select one of the following:* I will be presenting live. I will record my presentation ahead of time. I will use an existing recording of my presentation. Will you need our assistance with recording your presentation?* Yes No I'm not sure Please provide some date/time options for a BigMarker training session.*We need to collect some information from you for your Evergreen Webinar. We will need to know your credentials for EverWebinar and Calendly along with where we can find your pre-recorded webinar.Please choose from the following options as to where we can locate your pre-recorded webinar.* I will send a file CreativeOne's BigMarker Account Hosted on URL When did you host a webinar with our BigMarker account?*Please provide the date of the webinar you would like to use.Please provide the URL link of your pre-recorded webinar.*Do you have a scheduling platform (i.e. Calendly) that you currently use?* Yes No Please provide your personalized URL to set appointments.*i.e. calendly.com/companynamePlease provide your username and password for your calendar platform.*Please provide your username and password for EverWebinar.* Venue InformationWhat is the name of the venue you will be hosting your events?*Do you have permission from the venue to use their imagery? For example, building photos, menu items, logo, etc.* Yes No This is an important piece of our marketing as local imagery typically performs best.Please reach out to the venue to see if it is ok if we use any of the imagery from their website and/or social media profiles.Venue Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide any specific arrival and meeting room instructions.*This includes parking information, building name, room number, map, etc. It is very important that we can make it as easy as possible for the consumer to feel confident in attending.What is the total number of people the venue can hold?*What is the set menu for your dinner seminar?*Will you be hosting each event at the same venue?* Yes No We highly recommend having all your event dates at the same venue for better performance. By choosing another venue for this campaign, your seminar will not be guaranteed.Consent* I acknowledge that by choosing another venue, my seminar will not be guaranteed.We highly recommend having all your event dates at the same venue for better performance. By choosing another venue for this campaign, your seminar will not be guaranteed.What is the name of the second venue you will be hosting your events?*Second Venue Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide any specific directions for the second venue if necessary.*This includes parking information, building name, room number, map, etc. It is very important that we can make it as easy as possible for the consumer to feel confident in attending.What is the total number of people the second venue can hold?*What is the set menu for your dinner seminar at your second venue?*Dates for EventFirst Date:* MM slash DD slash YYYY First Date Start Time* : Hours Minutes AM PM AM/PM First Date End Time* : Hours Minutes AM PM AM/PM Second Date:* MM slash DD slash YYYY Second Date Start Time* : Hours Minutes AM PM AM/PM Second Date End Time* : Hours Minutes AM PM AM/PM Third Date:* MM slash DD slash YYYY Third Date Start Time* : Hours Minutes AM PM AM/PM Third Date End Time* : Hours Minutes AM PM AM/PM Presenter InformationAre you utilizing an outside speaker?* Yes No Guest Speaker's Name* First Last Have you confirmed dates with the speaker you are utilizing?* Yes No Make sure you confirm the dates of your event with the speakerHave you made payment arrangements with the speaker you are utlizing?* Yes No Make sure you setup a payment arrangement with the speaker.How many presenters are there for this event?* One Presenter Two Presenters Three Presenters Presenting Advisor's Name* First Last Has the presenting advisor hosted an event with CreativeOne before?* Yes No Please provide a company or personal biography for the presenting advisor.*You can also provide a link to the bio if you prefer.Please upload a photo/headshot of presenting advisor.Max. file size: 8 MB. Please upload a company logoMax. file size: 8 MB. What is presenting advisor's state license number?If applicable.Is the presenting advisor appointed with a Broker Dealer or RIA?* Yes No Please select with BD's or RIA's presenting advisor is affiliated with.*CreativeOne Wealth (formerly ChangePath)CreativeOne Securities (formerly Client One)CambridgeBerthel FisherCaltonOtherWhich broker dealer is the presenting advisor with?*Please write out any disclosures we will need to include.*We will need these every time you fill out a questionnaire to make sure your campaign is not delayed.Will you have an office staff member as a moderator for this webinar? Yes No Moderator's Name* First Last Moderator's Email Address* Second Presenter InformationSecond Presenter's Name* First Last Has this person presented at a CreativeOne hosted event before?* Yes No Please provide a company or personal biography for the second presenter.*You can also provide a link to the bio if you prefer.Please upload a photo/headshot of the second presenter.Max. file size: 8 MB. What is the second presenter's state license number?If applicable. Third PresenterThird Presenter's Name* First Last Has this person presented at a CreativeOne hosted event before?* Yes No Please provide a company or personal biography for the third presenter.*You can also provide a link to the bio if you prefer.What is the third presenter's state license number?If applicable.Please upload a photo/headshot of the third presenter.Max. file size: 8 MB. Submission Review{all_fields:nohidden} Terms and conditions apply for guaranteed reimbursements:View our Best Practices and Terms & Conditions.Terms & Conditions* I agree to the terms and conditionsTotal $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name Disclaimer for Registered Reps:The client has to submit retail communication approval requests for all events. They also have to submit their presentations and all material if it is not already approved. These requests will go in the queue with everyone else. Final approvals have to come from the rep or their assistant.