January 22 2019 Registration

Changes to Medicare Part D

This serves as a registration to attend the free presentation to "Changes to Medicare Part D" on January 22, 2019 from 9:30 a.m. - 12:30 p.m. at CT Valley Hospital, Lee Auditorium, Merritt Hall in Middletown, CT.

Question Title

* 1. In what capacity are you attending this presentation?

I am a pharmacist or work in a pharmacy

I am a mental health provider

I am a state employee

I work at a senior center

I am a municipal social worker

DMHAS employee

I am a Medicare recipient, family member or advocate

I am an insurance broker

I am a CHOICES certified counselor

I am a medical provider

Question Title

* 2. Please provide us with your contact information:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number