Get Mailing List Registration/database Entry Form

Filling out the Mailing List Registration/Database Entry Form accurately is essential for maintaining up-to-date contact information in the database. This guide will provide you with clear, step-by-step instructions to ensure your form is completed correctly and efficiently.

Follow the steps to complete your form with ease.

1. Press the ‘Get Form’ button to access the Mailing List Registration/Database Entry Form and open it in your preferred online editor.
2. Begin by entering the current date in the designated Date field at the top of the form.
3. Indicate whether you are adding, updating, or deleting information by selecting the appropriate option under the Please ADD, Please UPDATE, or Please DELETE sections.
4. Fill in your name as follows: first name, middle initial (if applicable), and last name in the Name field.
5. Provide your Title in the respective field to clarify your position.
6. Complete the Company field with the name of your organization.
7. Enter your Street Address, City, State, Telephone number, and Zip code accurately to ensure proper communication.
8. If applicable, fill in your Fax number in the dedicated field.
9. Provide a valid Email address in the Email field to receive correspondence related to your registration.
10. Complete the required fields marked with an asterisk (*) and ensure you meet the criteria for agent authorization and training completion.
11. If you are an agent or broker, enter your Individual License number in the Agent Individual License # field and indicate whether you are LTC Authorized and Partnership Authorized by selecting Yes or No.
12. If you are a non-agent or broker, select your affiliation from the list provided (e.g., Non-Profit Org., Trainer, Researcher, etc.)
13. Identify if you have completed Partnership CE Training and provide the name of the training organization and the completion date.
14. Review all filled-out fields for accuracy to ensure your submission is complete.
15. After verifying all information, you can save changes, download a copy, print the form, or share it as necessary.

Begin filling out your Mailing List Registration/Database Entry Form online today to ensure your information is accurately captured.