Complete this questionnaire and one of our trained M.I.N.D.copyright Risk Management System Financial Advisors will contact you. Take the first step towards achieving financial freedom.

1. Name (*)
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2. Address
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3. City
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4. State
   (select state)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIIIinoisIndianaLowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNaw YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingInvalid Input
5. Zip
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6. Preferred method of contact:
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7. Work Phone
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8. Home Phone
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9. Email
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10. The M.I.N.D.© Risk Management System is a wealth protection system designed for people who have accumulated a nest egg of $250,000 or greater (excluding residence and personal possessions).
11. Net Worth
    $250,000 - $500,000$500,001 - $1,000,000$1,000,001 - $5,000,000$5,000,000+Invalid Input
12. Are you retired?
    YesNoInvalid Input
13. Is most of your money in qualified accounts (IRA, 401k, etc.)?
    YesNoInvalid Input
14. Would you like to reduce taxes this year?
    YesNoInvalid Input
15. What is your biggest concern regarding your current portfolio?
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16. Enter value (numeric)
    
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