Choose Your In-Person Event Location and Date *

Aug 26, 2026 @ 5:00 PM - Black Bear Diner - 605 W Vista Way, Vista, CA 92083

What is Your Current Medicare Situation? *

I need help enrolling in Medicare.

I am already on Medicare.

Not on Medicare yet? When do you turn 65? (optional)

For How Many People Should We Reserve? *

Can't attend but would like Medicare assistance

What Is Your Plus One's Medicare Situation? *

Needs help enrolling in Medicare.

Already on Medicare.

Just attending as my support.

Name of Plus One *

First Name *

Last Name *

Email *

Phone *

I acknowledge that this is an educational event and there will be no selling. By providing my contact information, I consent to being reached by Daniel Hernandez (Licensed Insurance Agent, License #) via phone, email, or text regarding the Medicare workshop. You can reply STOP to unsubscribe at any time.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from Boomers Insurance Services at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.