Please select a location
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Colorado Springs, CO: August 6– 8, 2024
Woodbridge Township, NJ: August 13–15, 2024
Prefix
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Mr.
Mrs.
Miss
Ms.
Dr.
Suffix
Jr.
Sr.
Other
(please specify)
Organization
Job Title
Street Address 1
Street Address 2
Have you attended an NTP in person workshop before?
If yes, how many?
Please check the boxes that apply to you: (Check as many boxes as necessary.)
State Health Insurance Assistance Program (SHIP, SHIBA)
Tribal Organization
State or Local Government Agency
Federal Government
Medical Facility (e.g., hospital, clinic, doctor’s office pharmacy)
Health Insurance Plan/Agent/Broker
Advocacy Organization (e.g., a faith-based, condition-specific, or ethnic or racial interest group)
Professional Services Organization (e.g., consulting, legal services, financial services)
Community Living/Services (e.g., senior living facility, nursing home, retirement community, public housing)
How many people have you counseled on Medicare/Medicaid in the past year?
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0–25
25–50
50–100
100+
The intended audience for this training includes grantees; federal, state, and local government staff members; nonprofit organizations; and medical professionals and their staff members.
How many people have you trained on Medicare/Medicaid in the past year?
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0–25
25–50
50–100
100+
Whom will you be training using this information? (Check all that apply.)
My Own Staff
Medicare/Medicaid Enrollees
Pharmacists
Federal Government
State/Local Government
SHIP Counselors/Volunteers
Family Members
Other Community Organizations
Taking into consideration how many people you train and how many people they train and so on, how many people do you estimate will receive information flowing from this workshop?
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0–50
50–100
100–500
500–1,000
1,000+
The workshop venues are compliant with the Americans with Disabilities Act. We will make every reasonable effort to accommodate conference attendees. Please advise us of any special needs you have in the space below.
Please submit any questions you’re hoping will be covered during the workshop.
The workshop venues are compliant with the Americans with Disabilities Act. We will make every reasonable effort to accommodate conference attendees. Please advise us of any special needs you have in the space below.
