Please submit the following information so that we may:
  1. Approve you as an authorized Retirement Lesson Plan advisor.
  2. Include you in our searchable advisor directory so that teachers and others can easily find you.
  3. Create a profile page all about you, where teachers can contact you directly.

First Name *
Last Name *
E-mail Address *
Phone # *
Photo should be a professional headshot less than 1MB
Logo of your primary 403(b) company
Primary Logo is vendor logo (e.g. Security Benefits, MetLife, AXA, etc.)
Your DBA logo
Secondary Logo is independent advisor logo (e.g. One2One Wealth Strategies, Graystone Partners, etc.). We realize you may only have a primary logo.
Broker/Dealer disclosure statement
Self-enrollment data:

Link text:
Rep #
Plan #
Intro video (URL) URL:

Link text:
Do you offer variable annuities and or mutual funds?
Do you offer fixed insurance products?
Bio (< 1000 words)
Please select only the districts where you have a relationship.  Be sure that you have the Regional Manager (or company) approval to represent their product in all districts for which you are requesting approval.  “Flooding” districts with requests to be added, or not having company approval to represent a specific product, may result in your being barred from the site.  The site administrator will monitor activity to prevent these  abuses.
Districts -- select all that apply (to select multiple districts within a county, press the <ctrl> key)
Apache County
Cochise County
Coconino County
Gila County
Graham County
Greenlee County
La Paz County
Maricopa County
Mohave County
Navajo County
Pima County
Pinal County
Santa Cruz County
Yavapai County
Yuma County
Select the two primary counties where your work is concentrated:
What is the 1st county in which you work?
Use the control key to select more than one
What is the 2nd county in which you work?
Use the control key to select more than one
For all districts that have posted a Code of Conduct on their page, please confirm that  you have read and agree to comply with all conditions, including any security /  fingerprinting requirements for the districts you can provide service.
Do you agree?

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