講座班登記表

Name (required)

Address (please fill out if you would like to receive the care kit)

Email (required)

Phone

Which time would you like to register?
11/06/20 Fri 1-2pm - Dora (Chinese)11/13/20 Fri 1-2pm - Rick (English)11/14/20 Sat 1-2pm - Dora (Chinese)

Where/who did you hear about this event from?
Are you a CCHP member?
YesNo
What type of insurance do you have?
Would you like to be contacted for future events and insurance benefit information?
YesNo
by clicking the send button. you agree that a CCHP sales specialist may call to discuss CCHP Medicare health plan options for 2021. You agree that a sales specialist may call you even if your telephone number is on the National Do Not Call Registry. The person who will be discussing plan options with you is either employed or contracted by a Medicare health plan or prescription drug plan that is not the Federal government, and that person may be compensated based on your enrollment in a plan. Submitting this form does not affect your current enrollment, nor will it enroll you in a Medicare plan.