A. The following best describes my primary business activity: Select… Accounting Bank Investment Rep. Financial Planning Investment Advisor Insurance Securities Analyst Securities Broker, B/D Investment Management Other

If other, please specify:

B. Do you personally sell or recommend investments or advise clients on investments and/or asset management? Select… Yes No

C. Which license, registration and/or designation do you hold? (check all that apply) CPA CFP ChFC JC/LLB CLU CFA RIA or Assoc. RIA Other

If other, please specify:

D. What is your income source? Select… Please select one Fee only - percentage Fee only - hourly retainer Commission only Fees and Commission

E. What are the total assets under your management: Select… Please select one Not applicable Under $1 million $1 - $9.9 million $10 - $24.9 million $25 - $49.9 million $50 - $100 million Over $100 million

F. To which organization(s) do you belong? (check all that apply) NAPFA IIMC AIMR AICPA IMCA Other

If other, please specify:

First Name:

Last Name:

Company:

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