Sponsorship Form
Please provide the information for those you want to gift full sponsorship to. I will reach out to activate the $2,000.00 Accidental Death and Dismemberment Policy along with the other Living Benefits (Child Safety Kit, Will Kit, Plan Ahead Kit, AIL Discount Card and the Freedom Of Choice Certificate)
Insured's Name
First Name
Last Name
Sponsorship # 1
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
(City and State of Residence)
City
State
When do they get out of work? I don't want to reach out while they are working.
Sponsorship # 2
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
(City and State of Residence)
City
State
When do they get out of work? I don't want to reach out while they are working.
Sponsorship # 3
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
(City and State of Residence)
City
State
When do they get out of work? I don't want to reach out while they are working.
Sponsorship # 4
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
(City and State of Residence)
City
State
When do they get out of work? I don't want to reach out while they are working.
Sponsorship # 5
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
(City and State of Residence)
City
State
When do they get out of work? I don't want to reach out while they are working.
Submit
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