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POST /eventRegistration/eventRegistrationServlet

<form class="form-horizontal reg-form" novalidate="true" method="POST" action="/eventRegistration/eventRegistrationServlet">
  <div class="js-fields-container">
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="firstname" id="firstname" autocomplete="given-name"
          aria-describedby="firstname_error" aria-label="First Name" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="firstname"><span class="data-label">First Name</span><span class="required data-required">*</span></label>
      </div>
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    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="lastname" id="lastname" autocomplete="family-name"
          aria-describedby="lastname_error" aria-label="Last Name" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="lastname"><span class="data-label">Last Name</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="email" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="email" id="email" autocomplete="email" aria-describedby="email_error"
          aria-label="Email" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="email"><span class="data-label">Email</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="company" id="company" autocomplete="organization" aria-describedby="company_error"
          aria-label="Phone Number" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="company"><span class="data-label">Phone Number</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="address_street1" id="address_street1" autocomplete="address-line1"
          aria-describedby="address_street1_error" aria-label="Street Address 1" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="address_street1"><span class="data-label">Street Address 1</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="city" id="city" autocomplete="address-level2" aria-describedby="city_error"
          aria-label="City" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="city"><span class="data-label">City</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="state" id="state" autocomplete="address-level1" aria-describedby="state_error"
          aria-label="State" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="state"><span class="data-label">State</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="zip" id="zip" autocomplete="postal-code" aria-describedby="zip_error"
          aria-label="Postal Code" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="zip"><span class="data-label">Postal Code</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="padding-top: 6px; margin-bottom: 12px;">
      <div class="col-xs-12">
        <input type="text" class="form-control input-sm js-input data-input" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" maxlength="500" name="std1" id="std1" aria-describedby="std1_error"
          aria-label="Anticipated Retirement Date" required="required" style="z-index: 10;">
        <label class="placeholder-label js-label" aria-hidden="true" for="std1"><span class="data-label">Anticipated Retirement Date</span><span class="required data-required">*</span></label>
      </div>
    </div>
    <div class="row has-feedback reg-field" style="margin-bottom: 12px;">
      <div class="col-xs-12">
        <label class="drop-down-label js-label" for="std2"><span class="data-label">May we contact you regarding your Medicare options? Y/N</span><span class="required data-required">*</span></label>
        <select class="form-control input-sm js-select data-select" data-toggle="tooltip" data-placement="bottom" data-trigger="manual" name="std2" id="std2" required="required">
          <option value="Yes" selected=""> Yes </option>
          <option value="No"> No </option>
        </select>
      </div>
    </div>
    <div>
      <input class="data-input" type="hidden" name="deletecookie" value="true">
    </div>
    <div>
      <input class="data-input" type="hidden" name="selectedEventIDs" value="">
    </div>
    <div>
      <input class="data-input" type="hidden" name="target" value="reg20.jsp">
    </div>
    <div>
      <input class="data-input" type="hidden" name="eventid" value="4133446">
    </div>
    <div>
      <input class="data-input" type="hidden" name="sessionid" value="1">
    </div>
    <div>
      <input class="data-input" type="hidden" name="key" value="A1F237FFD567CB902AAA75AE1CDA6468">
    </div>
    <div>
      <input class="data-input" type="hidden" name="groupId" value="4559794">
    </div>
    <div>
      <input class="data-input" type="hidden" name="sourcepage" value="register">
    </div>
  </div>
  <div class="js-fields2-container" style="display: none;">
    <input type="text" name="secondaryEmailForNewsletter" value="">
    <label class="placeholder-label js-label" aria-hidden="true"><span class="data-label">Email for Newsletter</span><span class="required data-required">*</span></label>
  </div>
  <div class="js-fields2-container" style="display: none;">
    <input type="text" id="scDomainValue" name="scDomainValue" value="">
    <label class="placeholder-label js-label" aria-hidden="true"><span class="data-label">Domain Value</span><span class="required data-required">*</span></label>
  </div>
  <div class="submit-container">
    <div id="reg-recaptcha" class="g-recaptcha" data-sitekey="6Lexy1UUAAAAADAjfWUb54QPbjz7afAQbcgjdx62"></div>
    <p><span class="required">*</span>Denotes required.</p>
    <button id="regSubmitBtn" type="submit" class="btn btn-default submit-btn js-submit" style="border-color: rgb(204, 204, 204); background: rgb(224, 224, 224); color: rgb(51, 51, 51);"><strong>REGISTER</strong></button>
    <p class="enable-cookies-msg js-enable-cookies-msg" style="display: none;">Please enable Cookies in your browser before registering for the webcast.</p>
  </div>
</form>

Text Content

Webcasts
Select one or more of the following webcasts and complete registration. Click
any webcast listing to view its details.

Select All Virtual Meeting - Delaware
Available On Demand
Virtual Meeting - Delaware
Available On Demand
Virtual Meeting - Delaware
Available On Demand
Virtual Meeting - Delaware
Available On Demand
Virtual Meeting - Delaware
Available On Demand
Virtual Meeting - Delaware
Available On Demand

Warning! Please select at least one webcast.
Register Now

First Name*
Last Name*
Email*
Phone Number*
Street Address 1*
City*
State*
Postal Code*
Anticipated Retirement Date*
May we contact you regarding your Medicare options? Y/N* Yes No








Email for Newsletter*
Domain Value*

*Denotes required.

REGISTER

Please enable Cookies in your browser before registering for the webcast.


OVERVIEW

Title: Virtual Meeting - Delaware

Duration: 39 minutes

Available On Demand

Summary

Join us for a virtual meeting to learn about:

 * The different types of Medicare:
   * Parts A, B, C, D
   * Medigap
 * Medicare eligibility requirements
 * Enrollment deadlines
 * How to avoid penalties
 * Highmark Medicare plans available in your area
 * And more!

If you have additional questions after the webinar you can email Elena Cruchley
at Elena.Cruchley@highmark.com

To view additional webinar offerings available in your area, visit:



https://webinars.on24.com/highmark/VirtualMeetingsDE2023

There is no obligation to enroll.

For accommodations of persons with special needs at meetings, call
1-800-350-4135 and TTY may call 711.

Highmark BCBSD Inc. is a Medicare Advantage plan with a Medicare contract.
Enrollment in Highmark BCBSD Inc. depends on contract renewal.

Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield Delaware is an
independent licensee of the Blue Cross Blue Shield Association. All references
to “Highmark” in this document are references to the Highmark company that is
providing the member’s health benefits or health benefit administration.

The Plan complies with applicable Federal civil rights laws and does not
discriminate on the basis of race, color, national origin, age, disability, or
sex.



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