Please Choose Your Date/Time/Location *

Jan 03 @ 06:00 PM - Pizza Hut 123 street, Harrisburg, PA 17025

Can't attend but would like assistance.

How many seats should we reserve for you? *

1

2

N/A

Guest seats available for those 60 and older.

Which best describes your current Medicare situation? *

Need Medicare help ASAP.

Approaching enrollment in 1-3 months.

Approaching enrollment in 3-5 months.

Approaching enrollment in 6+ months.

I am already on Medicare and am interested in Medicare Advantage.

I am already on Medicare and am interested in Medicare Supplements.

I am already on Medicare and need help understanding my coverage/finding a better plan.

First Name *

Last Name *

Phone *

Email *

I agree to receive event reminders and follow‑up messages from Paul Zobel at American Senior Benefits at the phone number provided above and that Paul Zobel at American Senior Benefits may contact me regarding the educational workshop by phone, email, or text. Message & data rates may apply. Up to 4 SMS per event. Reply STOP to opt out or HELP for help.

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