Covered & Thriving Party RSVP 11.08.24
This is your pre-registration for the event, event will run 4-7pm and enrollment will be first come first serve.
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Et eo etam  *
Nomba eo am *
Email Address
Jete armej ej Itok ibbam ilo ien in? *
Bwe en bidodo am koba tok ilo ien in, kwoj ke aikuj am ri-ukok, Aet ak Jab?
Ewor ke moña/dren kwoj ladrik e (allergic) likit uak eo am, Ewor ak Ejelok. Ñe Ewor Jouj im likit etan moña/dren eo.
Ñe kwoj jerbal im kojjab approve ñon injuran ne an AHCCCS, kwoj konan ke enroll ñon Marketplace health injuran Ilo ien in? *
Elañe Aet? Jouj im boktok pepa aurok kein ñon ien in: 
Social eo am, Passport/i94 eo am
Pepa in kolla ak paystub ko am ñe kwoj jerbal
Jabrewot letta eo ej kwalok address eo am
Eliktata email, Ñe ejjelok Jenij jibañ eok koman am
More information: https://www.cms.gov/marketplace/outreach-and-education/marketplace-application-checklist.pdf
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