RIC & Voluntary Insurance Providers

DAS Human Resources Approved Providers for the Iowa Retirement Investors' Club (RIC) 457/401(a) Program & Voluntary Insurance Automatic Payroll Deduction (APD) program requesting to schedule informational events to distribute materials to State of Iowa employees, during non-work time, will need to complete this on-line application.

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Duly Authorized Event Requestor Representative
The Duly Authorized Event Requestor Representative must be 18 years or older to sign the MOU to commit the Event Requestor/Approved Provider to the event.
Representative's Name
 *
Address
 *
City
 *
State
 *
Zip Code
 *
Email Address
 *
Phone Number
 *
Format: ###-###-####
On-Site Event Requestor’s Representative
The following person will be on-site during the event.
Name (On-Site)
 *
Phone Number (On-Site)
 *
Format: ###-###-####
Email Address (On-Site)
 *
Event Requestor / Approved RIC or Voluntary Insurance Provider
Select your Approved Provider Benefit Program. *
Provide your Approved Provider's Webpage. *
Name (Requestor)
 *
Address (Requestor) *
City (Requestor) *
State (Requestor)
 *
Zip Code (Requestor)
 *
Event Information

Approved providers are able to select up to five information events per application. 

In the Event Detail text box, provide the arrangements for your event; i.e. list of equipment owned or rented from a 3rd party, timeline of activities including set up, tear down and any other event specific information.

Event Details
 *
Event 1 - Location
 *
Event 1 - Date
 *
Applications submitted prior to 6:00 a.m. one year in advance of the current date will not be reviewed.
MM
/
DD
/
YYYY
Event 1 -  Start Time
 *
Remember to include time to set up for the event.
Time
:
Event 1 - End Time
 *
Remember to include time to tear down and clean up after the event.
Time
:
Event 2
Event 2 - Location
Clear selection
Event 2 - Date
MM
/
DD
/
YYYY
Event 2 -  Start Time
Time
:
Event 2 - End Time
Time
:
Event 3
Event 3 - Location
Clear selection
Event 3 - Date
MM
/
DD
/
YYYY
Event 3 -  Start Time
Time
:
Event 3 - End Time
Time
:
Event 4
Event 4 - Location
Clear selection
Event 4 - Date
MM
/
DD
/
YYYY
Event 4 -  Start Time
Time
:
Event 4 - End Time
Time
:
Event 5
Event 5  - Location
Clear selection
Event 5 - Date
MM
/
DD
/
YYYY
Event 5 -  Start Time
Time
:
Event 5 - End Time
Time
:
Submit
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