Registration for the "Medicare is Under Attack" luncheon

Thanks for taking the time to let us know whether you’ll be able to join us for our luncheon.

If you don't have an email address cancel this registration and call 202-628-5095 to register for the lunch.

Radisson Hotel Harrisburg
Wednesday, November 18th, 2015 at 12 noon

1150 Camp Hill Bypass
Camp Hill, PA.

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* 1. Will you be attending this event?

Yes

No

Other (please specify)

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* 2. How many guests will you bring (you can bring up to 2 guests)

0

1

2

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* 3. What is your first name?

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* 4. What is your last name?

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* 5. What is your email address?

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* 6. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)