Workshop Registration First Name* Last Name* Email Address* Enter Email Confirm Email Phone Number*Zip Code How did you hear about us?*How did you hear about us?PostcardCompanyGoogleReferralOtherWhen are you eligible for Medicare (birth month)?*When are you eligible for Medicare (birth month)?JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDates*- Select a Date -Tuesday, March 21st – 6:00pmThursday, April 13th – 6:00pmThursday, May 18th – 6:00pmThursday, June 15th – 6:00pmNameThis field is for validation purposes and should be left unchanged.
