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Employer Application721 South Parker, Suite 200, Orange, CA 92868 (800) 5588003 www.calchoice.com (For CaliforniaChoice use only)Group #A Please complete using black ink Return signed and completed
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How to fill out authorized group contact

01
Obtain the authorized group contact form from the appropriate organization or department.
02
Fill out the contact details of the group leader or representative, including name, phone number, and email address.
03
Specify the name of the group or organization that the contact represents.
04
Provide any additional information or authorization required by the organization, such as signatures or official seals.
05
Submit the completed form to the designated recipient or office for approval and processing.

Who needs authorized group contact?

01
Authorized group contact is needed by organizations, institutions, or event coordinators who require a designated point of contact for a specific group or team.
02
This contact person acts as a liaison between the group members and the organization, facilitating communication and coordination for activities, events, or other purposes.
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Authorized group contact is a designated individual or entity authorized to represent a group for certain purposes.
Any group or organization that needs to designate a representative for official communication or decision-making may be required to file authorized group contact.
Authorized group contact forms are typically filled out by providing the necessary information about the designated representative, including their contact information and authorization details.
The purpose of authorized group contact is to establish a point of contact for official communication and decision-making on behalf of a group or organization.
Information such as the designated representative's name, contact information, authorization details, and the group or organization they are representing must be reported on authorized group contact.
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