WSIA Insurance Jeopardy Instructions Please answer the following questions to sign up your university for Insurance Jeopardy. There are 12 spots available and it will be on a first come, first served basis. Thank you! Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. University Name Question Title * 4. University Address Question Title * 5. To receive the $250 to be used at your event for food and beverage, please choose a payment option below on how you would like to receive payment. Check Direct deposit/ACH payment to a GIS account or University account e-gift card Question Title * 6. Please upload your university's W-9 for our records and in advance of your game date so that we can provide payment. If you have the ability to receive payment by ACH or direct deposit to the university or GIS account please contact Denise Marshall at denise@wsia.org to provide those details. Question Title * 7. Please provide three dates and times that work best for your schedule so that we can match WSIA members to your event. (Note: Dates should be submitted three weeks in advance.) Date / Time Date Time AM/PM - AM PM Date / Time Date Time AM/PM - AM PM Date / Time Date Time AM/PM - AM PM Question Title * 8. If you have more available dates you would like to list, you can list them here. Please include a start time too. Question Title * 9. Provide the address of where to ship the game buzzers. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Submit