Member Benefits Review

Next, enter some basic information in the fields below to reserve your spot.

Please fill out this form and click "Confirm Reservation" to reserve your seat at a Member Benefit Review meeting. We may contact you to remind you of your reservation.

Fields marked with an asterisk (*) are required.

First Name *Required Please enter your First Name. Please enter only letters.

Last Name *Required Please enter your Last Name. Please enter only letters.

Address *Required Please enter your Address.

Address 2 (if needed)

City *Required Please enter your City. Please enter only letters.

State *Required Please enter your state. Please enter a valid state(ex: PA, DE)

ZIP *Required Please enter your zip code. Please enter a valid zip code of 5 digits.

Date of Birth(mm/dd/yyyy) *Required Please enter your date of birth. Please enter a valid date of birth. Minimum age should be 18 years.

Please select how you would like to receive meeting reminders and updates

Phone Email

Please select an option

Phone Number *Required Please enter a valid phone number. Please enter a valid phone number. Can't start with 0 and 1. Can't be in formats (111) 111-1111 and (111) XXX-XXXX.

Email Address *Required Please enter your Email Address

Confirm Email Address *Required Please enter your Confirm Email Address Confirm Email Address doesn't match with Email Address field

I agree to the Highmark Health Data Protection Statement and Informed Consent for EU Data Subjects Please accept the Terms and Conditions