Submit a Medicare Event

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If you are an appointed agent with PacificSource Medicare, please use the instructions below to submit a Medicare event:

• Please submit events a minimum of two weeks prior to the event date to allow for effective marketing of the event.
• We understand there may be times when circumstances will prohibit you from submitting two weeks prior to the event and appreciate your timely submissions.

There are three types of events: formal sales event, informal sales event, and educational ABC’s event.

• Formal events are typically held in an audience/presenter style with a sales person or agent presenting information about the plans.
• Informal events are typically less structured or in a less formal environment (kiosk, RV, table booth).
• Educational events do not steer potential enrollees towards a plan, include sales activities, enrollment forms, or any plan materials.

Once you enter your event information, you will be able to review the information you entered prior to submitting. If you have questions about the event or this process, please email MedicareBrokerServices@pacificsource.com.

Event Information

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Event Name

Select an Event Name Formal: MA and MAPD Sales Presentation Informal: MA and MAPD Sales Event Educational: Medicare Class

Event Date

Event Time

AM PM

Facility Type

Select a Facility Type Food bank Grocery store Health Fair/State Fair/County Fair Health Fair/State Fair/County Fair Health Plan/Insurance Business Office or Facility Hospital Clinic/Conference Room/Business Office Hotel/Motel Library Mall kiosk Nursing Home/Skilled Nursing Facility/Rehab Facility Other Recreational Vehicle/RV Park Recreational/Community Center Religious Facility (Church/Temple/Mosque) Restaurant/Coffee Shop Retail Store/Store Front/Grocery Store School Senior Apartments/Senior Centers/ Assisted Living

Facility Type (Other)

Venue Details

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Venue Name

Venue Phone

Venue Address 1

Venue Address 2

Venue City

Venue State

Select a State ID MT OR WA

Venue Zip Code

Agent Information

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Agency

Agent NPN #

Agent Name

Contact Phone

Email Address

Additional Information

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Additional Notes

(Event overview, alternative registration instructions, advertising requests, ask questions, or request a follow-up)

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