Event Form

Event Form

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Community Outreach Event Form

If you are a community-based organization or school and would like us to attend your health fairs or other events, please fill out the inquiry form to tell us about your event.

* = required field

First Name*
Last Name*
Organization Name*
Email Address*
Phone
Type of Event*
If you selected "other," please describe your event.
Event Date
Address
City
State
Zip Code

 

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

All Rights Reserved.
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