Medicare Orientation Class RSVP Form

Thank you for your interest in attending the HIICAP Medicare Orientation seminar. Information on Medicare Part A and Part B, Medigap insurance, Medicare Advantage plans, Medicare Part D drug coverage and the Medicare Savings Programs will be covered.

The session will be held at 2 Lafayette Street, Manhattan - 6th floor in Room 624. Please enter your contact information to complete your registration. Seats are limited.

Should you have any questions, please do not hesitate to contact a HIICAP Medicare counselor at 212-602-4180 for assistance.

Sincerely,
HIICAP
NYC Department for the Aging

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* 1. Age

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* 2. Enter your contact information to reserve a seat.

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Reserving for Monday, September 9th, 10am- 12:30pm

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* 1. Age

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* 2. Enter your contact information to reserve a seat.

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* 4. INTERNAL HIICAP USE ONLY - DO NOT COMPLETE