Welcome to Medicare Program Onboarding

WTM Onboarding Form

Please submit one form per agent. Reach out to wtm@carolinaseniormarketing.com with any questions.
Agent Legal Name*

Legal First NameLast Name
Do you have a preferred name you'd like to go by?*

YesNo
Agent Preferred First Name*
Example: "Robert" -> "Rob": Leave Blank if your preferred name is the same as your legal first name!
NPN*
Principal Agent
Leave blank if you are the Principal
Agency Name*

WTM Onboarding Form
Have you previously hosted WTM meetings under CSM?*
What are the top 5 zip codes you would like to target?*
What are the top 2 venues you would like to host at in 2025?*
How many new clients did you enroll from your 2024 WTM Meetings?*
Email address you would like to receive online RSVPs at:*
example@example.com
Phone Number you would like to receive RSVPs at:*
Please enter a valid phone number.
Which of the following items do you need at this time for 2025 meetings?

2025 WTM BrochureSign-in SheetsWTM Thank You CardsA2 EnvelopesPermission To Contact CardsPresentation Slide DeckA-Frame Sidewalk Sign
What return address do you want on your Thank You Card Envelopes?*
Shipping Address to receive your WTM Materials?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you attest to reviewing the 2025 WTM Program training videos and rules at wtmresources.com prior to submitting this form?

By signing below, you agree to...
- Reviewing all guidelines and training on wtmresources.com
- Calling to confirm attendance with your leads as soon as you are notified
- Calling to remind your leads within 24 hours of your event
- Getting an accurate count of how attendees heard of your meeting and reporting your results promptly using our reimbursement form
- Collecting PTC forms and following up with your attendees within 24 hours to set an appointment
- Keeping track of sales made from WTM events within 2025, with the expectation to have written apps for 30-40% of your attendees
Please Sign*

Powered by Jotform SignClear
Would you like your online campaign to send auto SMS texts to your RSVPs? (We will need to get A2P campaign approval, please answer a few additional questions so we may submit a request on your behalf.)*

YesNo
Does your business have a Tax ID (E.g. EIN)?*

YesNo
What is your business registration number?*
9 digit EIN or SSN
What is the legal business name of your agency? (Enter the EXACT name as registered with the Government and tax documents.)*
What is your agency business type:*
Agency Business Type:*
What is your full business address as it appears on your tax documents?*
Comments or Questions:
Should be Empty:

WTM Onboarding Form

WTM Onboarding Form