Welcome to Medicare CCC – Registration Form

"*" indicates required fields

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.*

March 19, at 3:00 PM

April 9, at 3:00 PM

May 14, at 3:00 PM

June 11, at 3:00 PM

July 9, 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.

Name

This field is for validation purposes and should be left unchanged.

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This project was supported, in part by grant number CFDA 93.324 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

Some material on this website has been obtained from public records. Maps are Copyright © 2022 by Google Inc. or Microsoft Inc. The balance of the material is Copyright © 2008-2022 by Contra Costa County HICAP. All Rights are Reserved and material cannot be used without written permission.

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Welcome to Medicare CCC – Registration Form

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