INSTRUCTIONS: Please complete your application below by filling in the online form below. Those items marked * are required. Once you complete this application, you will receive a welcome letter via email in a few days from The CAS Institute explaining more about your membership and opportunities for you to get involved in iCAS.

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* 1. First Name

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* 2. Middle Name/Initial

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* 3. Last Name (Family Name/Surname)

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* 4. Address Line 1

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* 5. Address Line 2

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* 6. City

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* 7. State/Province

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* 8. Zip/Postal Code

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* 9. Country

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* 10. Date of Birth

  Month Day
Please enter your birth month and day:

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* 11. Year of Birth

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* 12. Gender

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* 13. Preferred Email

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* 14. Alternate Email

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* 15. Preferred Phone (add country code if not +1 in North America)

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* 16. Alternate Phone (add country code if not +1 in North America)

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* 17. Organization/Company

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* 18. Position/Title

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* 19. Current/recent occupation and/or job role

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* 20. LinkedIn Profile Link

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* 21. Your Academic Degrees - List each degree on a separate line - Degree, Major/Concentration, University/College/Institution (e.g., BA Math Temple University).

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* 22. Relevant Post-Graduate Academic Programs (non-degree) - Please list each program on a separate line: University/College/Institution, Type of Educational Program, Area(s) of Study, Number of Years Spent, and whether or not you completed the course/program.

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* 23. How did you learn about The CAS Institute?

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* 24. Professional Designations, Credentials, Certifications (not software certifications) (select all that apply):

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* 25. Relevant Online Courses, Bootcamps, In-depth seminars/master classes or other types of Educational Programs (describe briefly):

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* 26. In which of the following areas do you have significant background, qualifications or work experience (check all that apply)?

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* 27. Do you have significant interest in the Insurance Industry?

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