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Senior Health Insurance Benefits Assistance Program

SHIBA Speaker Request
Would your organization like a speaker on Medicare health issues? Fill out the speaker request form below and click the submit button and a SHIBA representative will contact you.

Contact information: 
Your name:  
Organization:
Phone:
Email:
County:  
Meeting date(s):  
Time:  
Number of participants:
Minimum participation may be required.
  
Comments:  

Topics (Select all that apply): 

Medicare basics
Part D prescription plans
Enrollment season options
Other
Other: