Registration Form

Mediaon October 5th, 2016Comments Off on Registration Form

Register for the Ohio Medicaid/Marketplace
Application Assistance: Best Practices

Training presented by:
Southwest Ohio Marketplace Assisters Workgroup

Date:
October 24, 2016, 12:30 pm-3:30 pm
(lunch provided)

Location:
Freestore Foodbank, Mayerson Distribution Center
1250 Tennessee Ave., Cincinnati, OH  45229
(On street parking available)

Contact Person:
Ryan Luckie, rluckie@freestorefoodbank.org, 513-357-4633


Are you:
NavigatorCertified Application CounselorAgent/BrokerOther

Other:

Name:

Agency:

Email Address:

Will you be attending the Networking Lunch from 12:30 pm-1pm?
YesNo

If yes, please list any dietary restrictions: