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?:  



View our Member Benefits Here

 
 
 
 
 
 
     
 Security code