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Refer a New Member

 

Referral Form

Complete the form below to make your referral. All fields must be filled in, unless noted, for a valid prize drawing entry.

Your Contact Information:

Name:
Policy Number
(if applicable):
Address:
City: State: ZIP:
Phone: Cell Phone:
Email (if available):

The Person You're Referring Is:

Name:
Address:
City: State: ZIP:
Phone: Cell Phone:
Email (if available):

Prize Drawing Rules:
Complete the referral form, above, on this page to be entered into a prize drawing.
  1. Invite your friends, family, neighbors, coworkers, and anyone else you know who believes in bringing families together, supporting our country, and helping others in need, to join National Mutual Benefit.
  2. The individual you refer must reside in Arizona, Colorado, Illinois, Iowa, Michigan, Minnesota, Nebraska, North Dakota, South Dakota, Wisconsin or Wyoming.
  3. The individual you refer must be at least 18 years of age.
  4. The referral form must be completed (non-required fields are noted) in its entirety to be entered in the drawing.
  5. The individual you refer cannot be a current member nor have had a policy within the last three years.
  6. You can only win one prize per year.
  7. Entries will be included in all drawings throughout the calendar year and only removed once chosen for a prize.
  8. The individual you refer does not need to become a member of NMB in order for you to be eligible to win a prize.
  9. Board members and field staff are not eligible to win a prize.
  10. This campaign in not available in states where prohibited by law. All interpretations of campaign rules will be made by the management of NMB and are final.
Form W0117