First Name *

Last Name *

Cell Phone *

Will a guest be joining you for this meeting? *

Each attendee is allowed to bring 1 guests with them to the event.

Who will be joining you? *

What is their relationship to you? *

Are they currently Medicare eligible or will soon to be? *

Would you like to receive text message reminders about the event? *

By selecting Yes, I give my express consent to receive telephone calls and text messages from Schopmeyer Medicare, Health and Life at the telephone number provided (which call/texts may be auto-dialed and/or use artificial or pre-recorded voices). I understand that my consent to receive calls/texts is not required in order to obtain Schopmeyer Medicare, Health and Life's products and/or services.