Member Questionnaire

Member Questionnaire

1. Please provide us with your current contact information to ensure that our records are complete and up to date (including email address):
2. What is your preferred method of contact from Assured Life Association?:



3. What is your age?:








4. How long have you been a benefit member of Assured Life Association (a benefit member is a person age 18 or older who has been issued and currently owns an inforce life insurance, Medicare supplement insurance or annuity certificate issued or assumed by the Society)?:






5. What is the highest level of education you have completed?:








8. How long have you been using the internet?:







9. Do you volunteer in your community?:



 
 
 
 
 
 

11. Do you donate money to charity each year?:



13. Have you used Assured Life’s matching charitable giving program for your donations?:




14. Assured Life Association has 4 national member service campaigns. Do these campaigns appeal to you? Check all those that appeal to you.:





16. Would you be interested in learning about the Committees of Assured Life Association and volunteering to serve on a committee?:

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