I have read and understand the agreement outlining the Terms and Conditions for receiving confidential information on the Life Insurance Protector™ and agree to be strictly bound by, and have consented to, those terms as a condition of receiving confidential information on the Life Insurance Protector™. I also consent to the collection and use of my personal information for the purpose of receiving, from R. Paul Jacobson, QC, more information on the Life Insurance Protector™ and to see if I qualify for such planning.