Insurance Enrollment Form
Deadline for returning form is April13, 2019
Even if you don't want insurance, you must send back enrollment form
PLEASE READ All OF THE INSTRUCTIONS BELOW.
(your browser may look different), download the enrollment form, fill out and save, then send as an attachment to firstname.lastname@example.org
(If you have trouble saving info you may have to “Save As”)
If you have any questions please call or email.
You could print it out and send or bring it in also.
NOTE: On a mobile device you will need to download Adobe Acrobat for Android or IOS (some apple phones may have problems). Go to Google Play to download the app. (The form will go into your downloads in your files folder on your phone). “You may have to go to “PRINT” to save”.
Below are instructions only, you will need to click on buttons above for forms.