2013 American Long-Term Care Insurance Sales Achievement Awards

2013 Long-Term Care Insurance Sales Achievement Awards

Be recognized as among the best in the business

Your opportunity to shine... to tell others that you are a leading producer nationally... or in your state.

IMPORTANT: Please read the instructions and rules prior to entering the Awards.

PRINT THIS PAGE AND FAX TO 818-597-3206 BY MAY 20, 2013


Free entries for the 2013 LTC Sales Achievement Awards closed on April 15th. In fairness and respect to those individuals who have already entered, we can not make exceptions. If you would like to enter and be recognized in the 2013 LTC Sourcebook, you can still enter using this form.

Manual entries will be accepted through May 20, 2013. There is a $40-per-person fee for the manual processing and you must be an Association member.

I wish to enter the awards contest and certify that the following information is accurate.

I authorize the American Association for Long-Term Care Insurance to charge the following credit card $40 for the manual entry fee ( Plus an additional $98 if I am not a member or my AALTCI membership needs renewing).



Credit Card Number:__________________________________________________



Expiration Date _________________ Security Code ______________




Signature: __________________________________________________



Address where you receive your credit card bill:



_____________________________________________________________



2013 AWARD ENTRY INFORMATION



First Name ___________________________________________________



Last Name_____________________________________________



E-mail Address:_____________________________________________________



State: _________________________________



What year did you sell your first LTC insurance policy? ______

Placed Premium: 2012 Individual LTCi: $_________________________



Number of Covered Lives: Indiv. LTCi Policies: ________________



Placed Premium MultiLife LTCi: 2012: $______________________



Number of Covered Lives: MultiLife LTCi: 2012: _________________



Life+LTC Premium (2012): $_________________________________



Annuity+LTC Premium (2012): $_________________________________



Please your print name again in case multiple pages get separated:



_____________________________________________________



Print out this page. It may print as 2 pages. Complete all information. Fax to the Association by May 20, 2013. We will acknowledge receipt by E-mail and you will be included in the 2013 LTCi Sourcebook. A copy of the Sourcebook will be mailed to all members mid-summer.

 Fax To: (818) 597-3206.



IMPORTANT: You must be a member of the American Association for Long-Term Care Insurance to be part of the Awards program and have your name published. If you are not a member or your membership needs to be renewed, you will be charged an additional $98 for 1 year membership.