BitShield Supporting Agent Interest Form

Interested in the BitShield Supporting Agent Pathway?

This event was the introduction. This form helps us understand where you may fit and whether you would like to be invited to the private Supporting Agent orientation.

Completing this form does not obligate you to join, become licensed, purchase anything, or move forward.

BitShield is a protection-first education initiative built around family protection, financial literacy, purchasing power education, responsible Bitcoin education, and purpose-driven leadership.

This interest form is for guests who want to learn more about the Supporting Agent / Strategy Partner pathway.

The next step is a private orientation where we explain the pathway, expectations, training, support, and how someone may fit.

Supporting Agent Interest Form

Fields marked * are required.

Full Name *

Phone Number *

Email Address *

City / State *

Who invited you?

Which best describes you? *

Are you currently licensed in life and health insurance? *

YesNoIn progressNot sure

What part of BitShield connected with you most? * (Select all that apply)

Are you interested in attending the private Supporting Agent orientation? *

YesMaybe, I have questions firstNot right now

Best way to contact you *

CallTextEmail

How soon would you like someone to follow up? *

Within 24 hoursThis weekI'm just exploring

What question would you like answered at orientation?

I understand that completing this form does not obligate me to join BitShield, become licensed, purchase anything, or move forward. I am requesting more information about the Supporting Agent / Strategy Partner pathway.

BitShield Initiative · Protection First · Education First · Service First