Welcome to Medicare CCC – Registration Form

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URL

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Please register for Welcome to Medicare, presented by Contra Costa HICAP. The class will be held "virtually" via ZOOM video conferencing. We will email the link to the ZOOM class approximately one week prior to the class.

Please complete the form below. An *asterisk indicates a required field.

Select the session you wish to attend*

NOTE: Sign up must be at least 24 hours in advance of the session.

December 16, at 3:00 PM

January 20, at 3:00 PM

February 17, at 3:00 PM

March 17, at 3:00 PM

Name*

First Last

Zip Code*

Email*

Enter Email Confirm Email

Phone*

Enter the best phone number to be reached on week days.

Optional: Enter any question or comment.

Do not provide any personal information.

Welcome to Medicare CCC – Registration Form

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