🔹 Personal Identity & Background

First Name *

Last Name *

Gender *

Email *

Phone *

Time Zone *

Preferred Name *

Current Career or Industry *

Date of birth *

Where do you live now? *

Fun fact about you *

Where did you grow up? *

Relationship Status *

Do you have kids? Ages? *

Licensed – Life Insurance *

✅ Yes

❌ No

Licensed – Investments *

✅ Yes

❌ No

Licensed – Mortgage Loans *

✅ Yes

❌ No

🌟 Lifestyle & Personality

“3 Words that describe your personality” *

3 Hobbies or Interests” *

“Favorite childhood TV show, movie, or artist” *

Role models or favorite public figures” *

Favorite quote, scripture, or mantra *

💼 Your Professional Vision

“What made you join Elite Empire (Primerica)? *

What part of the business excites you most? Check all that apply *

mostExcitingPart

Top 2 goals this year *

topGoals

Past industries or professional background *

careerBackground

🧠 Clarity on Your Ideal Client

Who do you most want to serve or help? *

idealClient

What financial struggles have you overcome? *

financialStruggles

Financial wins you're proud of *

financialWins

What money myth do you want to fix for others? *

moneyMyth

What do you want your profile to say about you? *

profileMessage

📲 Social Media Links & Content Style

Instagram Handle

TikTok Handle

Facebook Profile Link

Twitter Handle

LinkedIn URL

Upload Headshot (Optional)

Upload Headshot

Upload Lifestyle Image (Optional)

AI Avatar Requested *

Yes

Cultural/National Style – Other

Cultural or National Style *

Banner Style *

Preferred Content Style *

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By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.