MEDICARE 101 SEMINAR REGISTRATION PAGE

1) Bolingbrook - Fountaindale Public Library - Meeting Room C

Tuesday April 8th at 6:30 - 7:30 PM

2) Prairie Activity & Recreation Center - Multi Purpose Room

Tuesday April 29th at 6:30pm - 7:30pm

Please Complete the Seminar Registration Form and select which Seminar you will be attending the Seminar

Full Name *

Email *

Phone *

Select your Seminar Date

Mike & Kathy Foszcz

815-931-9242 or 815-263-8974

mike@kmfbenefits.com or kathy@kmfbenefits.com

www.kmfbenefits.com