State Health Insurance Assistance Programs - Presentation Request

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Saturday, April 21, 2018

Presentation Request

To request a presentation please fill out the below form and we will contact you regarding your request, please allow up to 5 business days for a response.

Our presentation typically covers the Medicare basics (Medicare Advantage, Prescription Drug, Medigap Plans, Low Income Subsidy), but if there are additional topics you would like us to cover please include them in the Additional Topics To Cover field.

Fields marked with a red dot ( Required ) are required to complete this form.

Request For Presentation

Event Name:
Event Location:
Presentation Date:
Start and End Time:
Event Type: Fair/Booth
Speaker/Presenter
Additional Topics To Cover:
Number of Attendees:
Parking Availability:
Contact Name:
Contact Phone:
Contact Email:
Additional Information:

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