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GIS New Member Form
Apply to become a new member of Gamma Iota Sigma!
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* Indicates required question
Applicant Information
Prefix
*
Mr.
Ms.
Mrs.
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Female
Male
Self-Identification
*
Asian
Black/African American
Hispanic or Latino
American Indian or Alaska Native
Native Hawaiian Pacific Islander
White
Two or More
Prefer Not to Answer
Date of Birth
*
MM
/
DD
/
YYYY
Phone Number
Your answer
Preferred Email
*
Your answer
Secondary Email
Your answer
Address Information
Permanent Address
Address
*
Your answer
City
*
Your answer
State/Province
*
Your answer
Zip/Postal Code
*
Your answer
Current Address
Address
Your answer
City
Your answer
State/Province
Your answer
Zip/Postal Code
Your answer
International Students
Are you an international student?
*
Yes
No
If yes, are you eligible to work in the United States?
Yes
No
Clear selection
Will you now or in the future require sponsorship for an employment visa?
Yes
No
Clear selection
What is your country of origin?
Your answer
Education Information
Expected Graduation Date
*
MM
/
DD
/
YYYY
Major 1
*
Your answer
Major 2
Your answer
Minor
Your answer
Course Work
*
Undergraduate
Graduate
Doctorate
Status
*
Part-Time
Full-Time
Designation Information
Currently Studying for Exams Offered By:
Canadian Institute of Actuaries
Casualty Actuarial Society
Insurance Institute of Canada
National Alliance for Insurance Research
Society of Actuaries
The American College
The Institutes
Other
Professional Designations
Your answer
Membership Add-ons
Membership Add-ons
Business Insurance Subscription
CPCU Membership
IABA Membership
International Association of Insurance Professionals Student Membership
IRMI Membership
National Alliance for Insurance Research and Education Membership
Professional Liability Underwriting Society Membership
The Insurance Library
Wholesale & Specialty Insurance Association
Casualty Actuarial Society Membership
High School Program Involvement
Were you introduced to GIS in High School?
*
Yes
No
How were you introduced to a career in insurance?
Faculty
Insurance Careers Month
MyPath
GIS Student Ambassador
InVEST
Other
Internship Information
Internship #1
Organization
Your answer
City
Your answer
State/Province
Your answer
Year
Your answer
Internship #2
Organization
Your answer
City
Your answer
State/Province
Your answer
Year
Your answer
Internship #3
Organization
Your answer
City
Your answer
State/Province
Your answer
Year
Your answer
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