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:

Address:

Address 2:

City:

State:

Zip:

Country (if not the USA):

Work Phone:

E-Mail: