WoodmenLife Please complete the form and click Submit to request contracting. Your upline manager will email a link to you from the WoodmenLife portal at AIMC. "*" indicates required fields This field is hidden when viewing the formEmail* This field is hidden when viewing the formName First Last This field is hidden when viewing the formResident State*Resident StateThis field is hidden when viewing the formDirect Manager*Direct ManagerThis field is hidden when viewing the formFMO*FMOThis field is hidden when viewing the formMGA*MGAThis field is hidden when viewing the formGA*GACurrently Contracted*Are you currently contracted with WoodmenLife? No Yes Contracting as*Contracting as Agent or Agency? Agent Agency Agent NPN*Agent NPNAgency Name*Agency Name as appears on licenseAgency NPN*Agency NPNResident State*Resident License State
