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Workshop Registration
infomixa
2022-03-02T19:05:03+00:00
Workshop Days:
Time:
Workshop Location:
Address:
Registration Deadline:
All workshop materials will be provided.
Agent Name
*
First
Last
Agent Email
*
Agent Mobile Phone
*
How many years have you been an agent?
*
Less than 1 year
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
22 Years
23 Years
24 Years
25 Years
26 Years
27 Years
28 Years
29 Years
30 Years
31 Years
32 Years
33 Years
34 Years
35 Years
36 Years
37 Years
38 Years
39 Years
40+ Years
How many team members do you have right now?
*
0
1
2
3
4
5
6
7
8
9
10+
How many additional team members are you looking to hire within the next 3 months?
*
0
1
2
3
4
5+
On average, how much money are you spending on marketing/leads on a monthly basis?
*
$0
Less than $500
$500 - $1,000
$1,000 - $2,000
$2,000 - $3,000
$3,000 - $4,000
$4,000 - $5,000
$5,000 - $6,000
$6,000 - $7,000
$7,000 - $8,000
$8,000 - $9,000
$9,000 - $10,000
$10,000+
On average, how much new business are you writing on a monthly basis?
*
Less than 10,000 in premium
10,000 - 20,000 in premium
20,000 - 30,000 in premium
30,000 - 40,000 in premium
40,000 - 50,000 in premium
50,000 - 60,000 in premium
60,000 - 70,000 in premium
70,000 - 80,000 in premium
80,000 - 90,000 in premium
100,000 - 125,000 in premium
125,000 - 150,000 in premium
150,000+ in premium
What are you looking to achieve with your agency in the next 12 months?
*
What are the top few things that are holding you back from achieving your goals as an agency?
*
What would you say are the biggest challenges that you have with your team members?
*
1st Workshop Participant
*
First
Last
Role In Agency
*
Sales
Service
Sales/Service
Additional Participants
*
No Additional Participants
1 Additional Participant
2 Additional Participants
3 Additional Participants
4 Additional Participants
2nd Participant
*
First
Last
Role In Agency
*
Sales
Service
Sales/Service
3rd Participant
*
First
Last
Role In Agency
*
Sales
Service
Sales/Service
4th Participant
*
First
Last
Role In Agency
*
Sales
Service
Sales/Service
5th Participant
*
First
Last
Role In Agency
*
Sales
Service
Sales/Service
I want to know a little bit about every participant that will be attending the workshop. Please list 1-2 things about each participant so that I can tailor my communication with them and their specific needs.
*
Add-On participant option is only to be used if you have previously registered or attended a workshop.
Coupon
I Have a coupon
Coupon
Total
$0.00
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
One Participant
Price:
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