TEST Submit Medicare Sales & Educational Events

Use this form to submit details for any upcoming Medicare sales or educational events so they can be shared and tracked for compliance.

Submit your event details before the event takes place, and submit attendee counts afterward using the same form.

Has your event taken place already? Yes

Event Information (Pre-Event)

*Required Fields

MCE ID

Contract Number

Other language (please specify)

Event Name

*Required Fields

Event Date

Please enter a valid Date, mm/dd/yyyy

Event Time

Brokerage Firm/Agency

*Required Fields

Venue Name

Other venue (please specify)

Venue Phone Number

Venue Address

Venue Address Line 2

Venue City

Venue ZIP

*Required Fields

Representative/Agent Name

Agent National Producer Number

Contact Name

Contact Phone Number

*Required Fields

Expected Number of attendees

Number of attendees

Special Notes or Instructions

Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121