RESPONSE SURVEY
Webinar Date
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Month
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Day
Year
Date
Name
*
First Name
Last Name
Birthdate
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Month
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Day
Year
Date
Spouse
First Name
Last Name
Spouse Birthdate
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Month
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Day
Year
Date
Best Phone Number to Reach You:
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Area Code
Phone Number
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I would want a private, One-on-One Phone Call or Virtual Meeting:
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YES! (please check below for reason for meeting)
MAYBE! - I have a few more questions first
NO THANKS! - I'm good for now
Choose One or More of the Following To Discuss In Our Meeting:
Too many costs and fees
I’m making back “Old Money”
I would like protection from market declines
I hold financial products that do not provide me with income for retirement
Other
I Currently Have:
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Stocks
Mutual Funds
CD's
Retirement Plans - Including but not limited to:(IRA/Roth/401K/457(b)/403(b)/TSP)
Stray 401k (From companies of past employment)
Life Insurance
Other
Best Day to Contact:
Monday
Tuesday
Wednesday
Thursday
Friday
Best Time to Contact
Morning
Afternoon
How did you hear about us? **Referrals please type the full name of the client who referred you.**
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I'm a client
Other
Please register me for the next Tax Free Green Line Webinar (Best email below)
Please sign me up for the weekly newsletter:
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YES
NO
I would like to refer someone I know that I think would like to hear more about the topics we discussed:
Yes!
Referral Name:
First Name
Last Name
Referral Contact Number:
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Area Code
Phone Number
Referral Email
example@example.com
Are there any other webinar topics you would like to see offered or any additional comments?
Thank you for your input
You will be contacted shortly to confirm dinner offer (if applicable)
(One offer per household)
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