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Association Membership Includes:
Association Membership includes exclusive access to:
Emergency Management (EM) Educational Material, Updates and Information.
Reduced rates at select EM events.
Discounts on Survival Products from 1-800-Prepare.com, FirstAidMart.com, MaxLifeFoods.com and TheReadyStore.com.
Receive discounts on the highest quality outdoor gear and emergency preparedness kits
Savings on Dell Computers and Electronics.
Savings on Hotels, Entertainment, Car Rentals and more.
Term Life Insurance.
AK, AL, AR, AZ, CA, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WA, WI, WV, WY
States Not Available
DE, MT, NH, NY, PR, VT, VI, AB, BC, MB, NB, NL, NT, NS, NU, ON, PE, QC, SK, YT
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AUTHORIZATION AND DISCLOSE INFORMATION:
Family Life Insurance Company and its reinsurers may obtain medical and other information in order to evaluate my application for insurance. I/we authorize any licensed physician, medical practitioner, hospital, clinic, pharmacy or pharmacy related facility or other medical related facility, insurance company, the MIB, Inc., Ingenix or other organization, other health care provider or governmental agency to provide Family Life Insurance Company or its reinsurers any and all medical records or knowledge, including entire medical records, to determine insurance and claim eligibility. This authorization will be valid for 30 months from the date signed. The information may involve me, or any care, treatment or advice of me. This includes information relating to alcohol or drug abuse, mental disease or information which may be considered a communicable or venereal disease which may include, but are not limited to, diseases such as Hepatitis, Syphilis, Gonorrhea and the Human Immunodeficiency Virus, also known as Acquired Immune Deficiency Syndrome (AIDS). Family Life may report such information to the Medical Information Bureau or to other insurance companies to which I have or may apply. This authorization will be valid for 2 years. A photocopy of this authorization will be as valid as the original. I, or my authorized representative may receive a copy of this authorization upon request. If applicable, I also have the right to receive notice of the reason for any adverse underwriting decision.
Any person who knowingly presents a false or fraudulent claim for payment of a loss or knowingly makes a false statement in an application for insurance may be guilty of criminal offense under state law. I agree that no insurance shall be in effect until: (a) a policy has been issued; and (b) the first premium is paid while my insurability remains unchanged and then only if I am actually in the state of health represented in this application. I state that the answers set forth above, are full, complete and true to the best of my knowledge and belief. The answers are to be the basis of any insurance issued. I also acknowledge that I have received the Investigative Consumer Reports notification and MIB Notice attached to this application. All statements made by or on behalf of the insured or annuitant shall be deemed to be representations and not warranties.
By entering your Mother's maiden name you are electronically signing the application thereby giving us authorization to obtain information and process the application. Clicking "Submit" acknowledges that you have read and agree to the Consent and Disclosure to Use Online E-Signatures. [ Click to print/download ]
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|* Free on orders of $50 or more