First Name:  * Last Name:  * Address:  * City:  * State:  * Zip Code:  * Email Address:  * Phone:  * Fax: Cell:  *   Select Consultant -- Select One --Carlos P 1076Carmen C 1045Chuck L 1068Chuck Q 1059Claire L 1066Diane G 1079Gaetano F 1089Gaura T 1063Jeanette M 1082Joanne A 1053Judi H 1002Mark/Carol D 1084Norma M 1054Ray E 1020Richard H 1067Robb Z 1031Ronald W 1064Sandra C 1075Tamazi G 1043Tom C 1065Tom B 1060Vicki S 1069 Consultant Name Selected  *   Choose Referrer Program: Select oneEnhanced Gold - membership requiredBasic - membership not required   Newsletter Signup Select1) I have already done so2) I will signup following this signup.   1) I have completed & understand the Basic Study Guide. SelectYesNo   2) I have completed & understand the Asset Protection Study Guide. SelectYes - MembersNo - Non member   3) I am ready to send prospects to the web site now: SelectYesNo   4) I will or have ordered FCUSA business cards: SelectWill order in Gold ProgramOrdering separatelyAlready have FCUSA cards   5) I will promote FCUSA with approved FCUSA flyers and business cards only: SelectYesNo   6) I will allow prospects to ask for membership or a process - not ask them. SelectYesNo   7) I agree to follow FCUSA guidelines and refer questions not answered in the flyer to my consultant - live calls - web or taped calls. SelectYesNo   8) I understand my commission is based solely on memberships and full pay programs: SelectYesNo   9) I have read and agree to the terms of the FCUSA Referrer Agreement with my electronic SIGNATURE:  *   Comments: Security code:   * Do not enter anything in this field:

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