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First name

Last name

Reference Number

Email (Note: This is the email address where your funds were sent)

Region

Branch

Activity Information:

Activity Date

Activity Name

Number of Actual Participants

Who participated? (Ex: Branch Councillors, Regional Councillors, general members, non-members, etc.)

Summary of Activity (include best practices that can be shared with other member leaders)

Total Funds Received

Actual Activity Cost

Unused Funds Remaining for Subsequent Activity

Please attach itemized receipts here

Were there any incidents that you want to report?

Please provide your overall feedback on the application process and/or activity.

Disclaimers

Foresters life insurance products and riders may not be available or approved in all states and are subject to eligibility requirements, underwriting approval, limitations, contract terms and conditions, and state variations. Refer to the applicable Foresters Producer Guide and the insurance contract for your state for these terms and conditions. Underwritten by The Independent Order of Foresters.

On compatible devices.
Insurability depends on answers to medical and other application questions and underwriting searches and review.
e-App is available through the iPipeline iGO e-App platform using Microsoft Edge (desktop/laptop) or Safari (Apple iPad only) for Foresters non-medical and medical products (excluding Foresters PlanRight). Touch to Sign is available on Apple iPad only. POS decision for non-medical products will be unavailable Monday to Saturday from 2:00 a.m. to 6:00 a.m. and from Saturday 10:00 p.m. to Sunday 10:00 a.m. (ET).