Covered & Thriving Party RSVP 11.08.24

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This is your pre-registration for the event, event will run 4-7pm and enrollment will be first come first serve.

First & Last Name *

Phone Number *

Email Address

How many people are attending, including yourself? *

Do you need any accommodations, such as interpretation, to make your attendance easier?

do you have any food allergies or preferences?

Would you like to enroll for Marketplace Health Insurance at the event? *

If yes, please bring the following documents with you:
Social Security Card and Immigration documents

Income information if you are working

Anything with your address on it

Create an email address if you know how and don't have one

Submit

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