Agency Benefits Officers - Request Representative | FLTCIP

Request a Representative

Want us to conduct an onsite workshop, speak at your pre-retirement seminar, or attend your health, wellness, or financial fair? The information you provide will help us determine the most appropriate resource for your event.

Event Information

Category

Event start date

Multi-day event (optional)

No Yes

Number of days

Start time

End time

RSVP deadline date (optional)

Total number of employees at your location

Total number expected to attend the event

Contact Information (for the day of the event)

First name

Last name

Department or agency

Phone Number

Email

Are you the main agency benefits officer (ABO) at your location?

No Yes

ABO first name

ABO last name

Phone Number

Email

Event Location

Room name or number (optional)

Zipcode

State

City

Address + Add Address Line (optional)

Address Line 2

Shipping Address

Contact first name

Contact last name

Zipcode

State

City

Address + Add Address Line (optional)

Address Line 2

Shipping instructions

(optional)

Indicate any special shipping instructions, such as "ship via FedEx only" or request materials to arrive on or before a specific date.

Notes

(optional)

Detail any special security provisions necessary for us to gain access to the event location, such as two forms of identification, a license number, vehicle information, or a Social Security Number.

Share any other details about the event (optional)