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Application
If you are interested in being part of the Platinum Advisors, fill out the application below.
Full Name:
*
Email
*
Address
*
City:
*
State:
*
Zip Code:
*
Cell Phone
*
Work Phone
*
Qualifications
Are you an active NAHU member in good standing?
*
Yes
No
Are you a member of LPRT - Leading Producers Roundtable?
*
Yes
No
Do you own your agency/brokerage and able to authorize purchasing decisions for your agency/brokerage?
*
Yes
No
How many years have you owned your agency/brokerage?
*
Does your agency/brokerage have less than 15 employees (including benefits producers, account managers, and staff)?
*
Yes
No
Are you willing to share and help others within the PAN, your best practices and ideas (knowing this group does not compete with you)?
*
Yes
No
Are you willing to refer opportunities to others within PAN if they should arise (for agreed upon compensation splits)?
*
Yes
No
Are you willing to prioritize opportunities referred to you by other PAN members (and split compensation) should they arise?
*
Yes
No
NAHU Specifics
What STATE chapter of NAHU do you belong?
*
What LOCAL chapter (if any) of NAHU do you belong?
*
Have you and if so, what positions do you hold within local, state or national levels of NAHU (include dates)?
*
What awards (if any) have you won within local, state or national levels of NAHU?
*
At what level do you contribute to HUPAC and for how many years?
*
Practice Areas
What areas of practice within the insurance industry do you specialize (i.e. Medicare, Small/Large group, fully insured/self-funding, life, disability, voluntary worksite, etc)?
*
Please list three professional references that we may contact about you. Reference #1
Name
Company
Full Address
Relationship
Phone
Reference #2
Name
Company
Full adddress
Relationship
Phone
Reference #3
Name
Company
Full Address
Relationship
Phone
Extra Information
Please comment on additional attributes you believe distinguish you from others that will qualify you to become a member of PAN.
Disclaimer
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in this application process may result in my disqualification to PAN and that information provided will be confirmed. I also understand that completing this application does not automatically qualify me for immediate membership into PAN.
*
Are You A Robot?
*