EQULearning Institute


 

EQ LICENSING & MTA CERTIFICATION APPLICATION

Please provide us with as much of the following information as possible:

First Name

Last Name

Company name (if applicable)

Address

City

State/Prov

 Other:
Country

Zip

Telephone

 Cell:

Fax

E-mail
Most of our communication with you will be done via email
I have attended a previous EQ boot camp No     Yes
Date of Birth mm/dd/year
 
Level of participation you are interested in:  Full EQ and MTA training   Money Technologies (MTA) only
What is your present occupation?
Are you a Field Rep for  any company? Broker Insurance   Financial Entity
Other:
Are you presently, or have you ever been licensed: Never licensed Presently licensed   Was licensed 
in:
What type of license do you presently or did have? Life Insurance   Securities   Mortgage
Other:
If not licensed for insurance, what are your intentions in that regard? Register with Mike Russ Financial Training Centers or Dearborn
Get licensed my own way (other school, home study, etc)
I don't plan to get licensed, as I just want to refer people for the insurance side
I don't know yet
Would you like to work with us:
Ready now: Part time Full time Occasionally
Will soon: Part time Full time Occasionally
In what general geographical area would you like to work?
Which training would you like to attend?

Please see Fact Sheet for scheduled training
2009 TRAINING ASAP Future training
Full training (Licensing & Marketing)
 + MTA Certification 
EQ Only
Marketing only (without getting licensed by EQ)
Would you need financial assistance in order to take the full training? Yes No  Maybe  (a $4,000 scholarship is available for all accepted attendees)
In the event we offer a Trainer's training  after a Boot Camp, would you like to attend? Yes No  Maybe
Where are you planning to stay during training? Home    With friend or relative
Hotel  -  if so, click here for Hotel info
I don't know yet
How did you initially find out about this training and/or Licensing opportunity? Television Commercial
Magazine Advertisement
Newsgroup Posting
Online marketing
Search Engine
Word-of-mouth
Referred by someone, or seminar/workshop (please specify)
     
IMPORTANT: When attending your EQ Boot Camp and MTA training, are you planning to invite guests for a tour of the office + properties
Yes  No  Maybe   How many guests?
Comments/Questions

Note: If first boot camp, minimum deposit in the amount of $500 will be required if/when your application is approved and an additional $500 will be required BEFORE starting the boot camp. Scholarships are available for the remaining portion of the training fees. 

© 2008, Equidigm Financial Solutions, LLC