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1. Do you provide financial planning services and investment advice?	Select One Yes No
2. Which best describes your title?	Select One Financial Planner/Investment Advisor Investment Manager/Consultant Personal Financial Planner/Specialist Insurance Agent Stockbroker/Registered Representative Accountant CPA President, CEO, Principal Partner, VP Attorney Trust/Private Banking Officer Sales Management Professor/Student/Librarian Other
3. Primary business?	Select One Independent financial planning firm/RIA/Investment Advisory Insurance broker-dealer Full Service Securities/Brokerages/Broker-Dealer Accounting Firm Other
4. What licenses do you currently hold? (Check all that apply)	CFP ChFC CLU CFA LUTFC Series 54 RIA CPA Series 23 Life/Health Series 6 Series 7 Series 22 Variable Life Series 55 Series 63 Series 65 Other
5. What is the approximate value of your total assets under management?	Select One $50 million and over $25 - $49 million $10 - $24 million $5 - $9 million $1 - $4 million Under $1 million
6. What is your income source?	Commission Only Fee Only Fees and Commission Other
7. Who is your broker-dealer?	Select One 1717 Capital Management Co. American General Securities Inc. Advantage Capital Corp. Associated Securities Corp. Brecek & Young Advisors, Inc. Broker Dealer Financial Services Corp. Cadaret, Grant & Co., Inc. Cambridge Investment Research, Inc. Century Securities Commonwealth Financial Network Equitas America, L.L.C. Equity Services, Inc. Financial Network Investment Corp. Financial Service Corp. First Allied Securities, Inc. FFP Securities Inc. H. Beck, Inc. Harbour Investments, Inc. Hornor, Townsend & Kent, Inc. ING Financial Partners, Inc. INVEST Financial Corp. Investacorp, Inc. Investment Centers of America, Inc. Investors Capital Corp. Inter Securities, Inc. Jefferson Pilot Securities Corp. Lincoln Financial Advisors Linsco/Private Ledger LaSalle St. Securities Kovack Securities Inc. MML Investors Services, Inc. MONY Securities Corp. Multi-Financial Securities Corp. National Planning Corp. NEXT Financial Group, Inc. NFP Securities, Inc. Northeast Securities, Inc. NYLIFE Securities Inc. Park Avenue Securities, LLC Princor Financial Services Raymond James Financial Services, Inc. Round Hill Securities, Inc. Royal Alliance Associates, Inc. SAL Financial Services, Inc. Securian Financial Services, Inc. Securities America, Inc. Securities Service NCapital Analysts Inc. Sentra Securities Corp., Spelman & Co., Inc. SII Investments, Inc. Signal Securities, Inc. Signator Investors, Inc. SunAmerica Securities, Inc. ProEquities The Investment Center, Inc. The O.N. Equity Sales Company (ONESCO) Tower Square Securities, Inc. Transamerica Financial Advisors, Inc. Triad Advisors, Inc. United Planners' Financial Services of America USAllianz Securities VSR Financial Services, Inc. WRP Investments, Inc. WS Griffith Securities, Inc. Other None
8. Custodial Affiliation	Select One Fiserv Fidelity Pershing Schwab TD Waterhouse Other None
9. Registration with state and/or federal regulatory agencies (Check all that apply)	My own RIA Advisor representative of a Non Broker-Dealer RIA Registered Representative/Principal with the NASD State RIA/RIA Affiliate SEC RIA/RIA Affiliate None Other
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