Organization manager
Address
City
State
Zip
Phone
Email
Full name of organization/company affiliation
Contact person if other than organization manager
Local association to which head officer belongs
Is the head officer currently a member of GAMA International?
Yes
No
The organization manager must be an active member of NAIFA and GAMA International.
Total number of eligible agents in your office
Number of those eligible agents who are NAIFA members
Please list all eligible agents/producers in your organization.
If you require additional space, please email your list to:
mma@naifa.org
NAIFA ID numbers are required for processing. This can be found on agents'
Advisor Today
mailing label. For privacy purposes, only individual members may contact the NAIFA Member Service Center to request their ID number. Social Security numbers will not be accepted. We are unable to provide lists of NAIFA members to agencies.
FIRST NAME
LAST NAME
NAIFA ID*
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* Can be found on your
Advisor Today
mailing label or you may call the NAIFA Member Service Center at 877.866.2432
Name of person submitting award
Date