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VADIP Group Meeting Request Form

To request a MetLife representative to attend your Veteran meeting or event, please enter your information below. If you are requesting support for more than one location or for multiple dates, please submit a separate request.


* Required Fields

Agency Information

Customer Name
*Agency/Location Name RRvalidation.gif>> Required
*Street Address (Cannot be a PO Box) RRvalidation.gif>> Required
Address 2 (Cannot be a PO Box)
*City RRvalidation.gif>> Required
*State RRvalidation.gif>> Required
*Zip RRvalidation.gif>> Required
Room Name
*Contact First Name RRvalidation.gif>> Required
*Last Name RRvalidation.gif>> Required
*Phone # RRvalidation.gif>> Invalid (XXX-XXX-XXXX)
Phone Extension
*Email Address RRvalidation.gif>> Invalid Email Address
*Alternate Contact Name RRvalidation.gif>> Required
*Alternate Contact Email Address RRvalidation.gif>> Invalid Email Address
*Alternate Contact Phone # RRvalidation.gif>> Invalid (XXX-XXX-XXXX)
Phone Extension

Event Information

*Event Date RRvalidation.gif>> Required
*Event Start Time RRvalidation.gif>> Required
*Event End Time RRvalidation.gif>> Required
*# Veterans at this Location RRvalidation.gif>> Required
*# Expected to attend at this Event RRvalidation.gif>> Required

Shipping Address

(Check if same as Agency Address)  

MetLife will ship materials to this event. You do not need to order them.

*Shipping Address (Cannot ship to PO box) RRvalidation.gif>> Required
Shipping Address 2 (Cannot ship to PO box)
*City RRvalidation.gif>> Required
*State RRvalidation.gif>> Required
*Zip RRvalidation.gif>> Required
*Shipping Contact First Name RRvalidation.gif>> Required
*Shipping Contact Last Name RRvalidation.gif>> Required
*Shipping Contact Phone # RRvalidation.gif>> Invalid (XXX-XXX-XXXX)
Phone Extension

Special Requests

Comments
 
Submission of this request does not guarantee representation at your event.
 

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PEANUTS © 2014 Peanuts Worldwide LLC

Last updated on 2/12/09. For Broker/Dealer Use only. Not for Public Distribution.