Team Members Hall of Fame - Participant Registration Form

2026 Participant Registration Form

Registration is open beginning each December. Agents must sign participants up before the March 31 deadline. Qualification runs January 1-October 31! Late registration, April 1, is $150 (Does not apply to newly licensed TMs)
Team Member Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Team Member State Farm Alias
Has Team Member participated previously - Choose "No" if previously registered but never qualified
Date of Hire

MonthDayYear
Date
**For late registration of team members hired prior to 3/31, qualification is based on production as of registration date.

EX: John is hired on 1/1/26, but registered for Team Member Hall of Fame on 5/1/2026. John's production will be measured from 5/1/2026. Any production prior to 5/1/2026 will not be eligible.
2026 Territory assignment
Please choose from the dropdown
Sponsor Agent Info

Agent First NameAgent Last Name

ONLY ONE Team Member per registration form!

$100.00 Quantity

Total

2026 Participant Registration Form