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Are you currently a Waddell & Reed client?*

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If so, who is your financial advisor?

If so, please provide your account number so that we can better assist you:

First Name*

Last Name*

Address*

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E-mail Address*

It may be necessary for us to contact you by phone in order to respond to your inquiry. Therefore, please provide the following information:

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How were you referred to Waddell & Reed?

My primary investment concerns are:

	Education Funding		Retirement Funding		Retirement Income
	Investment Results		Protection Needs