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Medicare Advantage Sales Event Form

CareFirst must be notified of all sales events 14 business days prior to the scheduled event.

*Required

Name of FMO*

Agent's First Name*

Agent's Last Name*

Phone Number

Email*

Agent NPN*

Name of Agent presenting if different from above

Presenting Agent NPN

Event Information

Date of Event*

Event Start Time*

Event End Time*

If hosting a live event

Venue Name*

Venue Type*

Venue Address*

Venue Phone Number*

If hosting a webinar

Webinar invitation details*

Number of people invited

Capacity

Briefly describe what product(s) will be discussed at the event*

Will you need extra support from CareFirst BCBS to manage event?

If yes, select the support you’ll need (check all that apply):

Sales Materials
Product-branded Giveaways
Virtual Event Support
Other

Please complete all required fields and submit.