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The Third National Medicare RAC Summit March 4 5, 2010 Renaissance Washington DC Hotel, Washington, DC Sponsor/Exhibitor Application Company Name: Company Representative: Street Address: City: State:

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How to fill out form third national medicare:

1. Start by gathering all the necessary information and documents required to complete the form. This may include personal identification details, employment history, and income information.
2. Carefully read through the instructions on the form to understand the requirements and any specific guidelines for filling it out.
3. Begin by filling out the basic personal information section, including your full name, date of birth, address, and contact details.
4. Provide details about your current healthcare coverage, such as the name of your insurance provider and policy number.
5. Indicate whether you are applying for yourself or on behalf of someone else, providing their relevant information if applicable.
6. Fill in the sections related to your income, including information about your employer and any other sources of income.
7. If you have any additional healthcare coverage, such as through Medicaid or other government programs, provide the necessary details and documentation.
8. Review the completed form thoroughly to ensure all information is accurate and complete. Make any necessary corrections or additions.
9. Sign and date the form in the designated places. If you are completing the form on behalf of someone else, include your relationship to the individual and your contact details.
10. Submit the filled-out form as instructed, either by mail or electronically, keeping a copy for your records.

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