J6 Invitation to GoldCare - A Holiday Gift for You & Your Family

We appreciate your interest in GoldCare.  Please complete the following questions so that we may verify your eligibility for this free J6 membership offer.  A representative from GoldCare will then follow up with you to confirm eligibility and complete your enrollment.

This invitation is for a FREE GoldCare Membership:

·       $10/month value for individuals or $20/month for you/spouse/minor children.

·       Your Membership will give access to many of GoldCare’s services for no charge.

·       Appointments, prescriptions, and other optional services are affordably priced and pay-as-you-go.

·       This invitation applies only to J6 Individuals, their spouses, and dependent children and is not transferable.

·       There is no expiration date on this free GoldCare membership offer.

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J6er First & Last Name *
Phone Number *
Email Address *
J6er Spouse's First & Last Name (if applicable)
J6 Case Number *
Name of Person Submitting this Enrollment Request (if different than above)
Relationship to J6er
Submit
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