MDwise Member Advisory Committee Meeting Registration Form

Member Advisory Committee Meeting Registration Form

*Indicates required information

MDwise invites you to a Member Advisory Committee (MAC) Meeting.

At the meeting, you will learn about your MDwise benefits and community resources. You will also have a chance to tell MDwise what you like about your health coverage and what you think needs improved.

We offer free transportation and interpretation services for the in-person meetings. To request these services, please call MDwise Customer Service at 1-800-356-1204

You can earn a $25 gift card for your participation in both in-person and virtual MAC meetings.

Having trouble registering? Please call MDwise Customer Service at 1-800-356-1204, for help.

To be eligible for the $25 gift card: You must register, and you must be an active MDwise member. Gift cards are limited to one (1) per member per quarter. MDwise members must be present during the entire presentation to be eligible.

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country: *

Email Address *

Date Attending *

Location Attending *

Preferred Language *

Member Identification Number *

How did you hear about this meeting? *

Captcha*

DR-03-2024-12175/HHW-HIPM1156 (3/24)