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 with Boomers Insurance Services, National Producer ID 13980000) 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 text messages from Boomers Insurance Services at the phone number provided, including Medicare workshop invitations and educational updates. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.