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To our Valued Customer:
Below is some information that will help us to begin the health/benefit fair scheduling process for you. Please complete and return it to an Employer Service Coordinator to schedule an event.
There are three ways to return this form:
e-mail : HYPERLINK "mailto:eshcomments@cign.com" eshcomments@cign.com fax: 1.952.996.2702 mail: CIGNA
Attn: Employer Service Coordinators
11095 Viking Drive, Suite 350
Eden Prairie, MN 55344
Please note that we request a minimum of four weeks notice when scheduling an event. This enables us to schedule an appropriate, prepared, well-qualified provider for your on-site training. Thank you and we look forward to serving you in the future.
Company Information
Company name:
Site contact and phone number:
Physical Address:
City:
State:
Zip Code:
Number of employees on site:
Type of business:
Health/Benefits Fair Specifics
Date(s):
Time(s):
Number of participants anticipated:
Additional Information:
Please note:
Four (4) weeks advance notice is required
Cancellations or changes made with less than 5 full business days notice will be billed to the Employer Service Hours for your company.
Feel free to add any additional questions, comments, or specifications below:
Health & Benefit Fairs
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s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s Bs {s s s { s ss { s s s { s ss s s { s s s s s { s s s { s s s { s ss s s s s {s s ν{s s { s { s {s s ƵsƔ{ s s s 9s s s { BƔΥ1s s s s s s ccs s { s s s { s { s { s s s { s ss s s s s { s ss {s s BƵsνk1{ s s s { s s s { s s s { s s s { s s s Bs s s s s s s s s s s s s s s s s s s s s s s s s k s s s s s s s s s s s s s s s s 1ƽ{s s s s s s s s s s !s s s s ƽ{ƽ{s s ƵsƜ!s s s s s ZΥ{s s s s s s s s s s s s s s s s s s s s s s s s s Ƶs罭cs s s s s s s s s s s s s s s s s s Bs s s { s s s { s s s { s s s { s s s { s s s { s { s {s ss ss s s { s ss { {νs { s { s { s s s ss ss ss 1s sƵsR{ s s s s1֭1s { s s s s s ss s s s s { s s s { s s s ss Υ֥s { s { s s s s s s s { s s s { s Bs s s s s s s s s s s s s s s s s s s s s s s s RƔΥc{s s s s s ƭkƔs s s s s s s s s s 9Μs s s s s s 1s !cs s s s s )ｭcs s s s s s s s s s s s k s s s s s s s s Rcs s k s s s s s s s s s s s s s ֭ Bs s s s s { s s s { s s s ss s s { s s s !ΥƔ{ν!ss s s { s { s { s Bνs s s s s s ƵsΥs s B{ s { s s{ֵ{{ s s s ss s s { s s s {s { s { s s ss s s { s s s { s s s { s s s ν 9s s s s s s s s s s s s s s s s s s s s νƔΥΜs s s s s s s s s JƔcs s s s s s !{s Z{s s s s s RRs s { s s s s s s s s s s s s s s )s s s s s s s s s s s s s s s ε{ 1s s s s s s s { s s s { s s s s s { {ֵB{!s { s { s s s 1ֵ1s { s { s Ƅs ss s s ss { ֭s s s s s s s ss s s s s s s BBs { s s s ss s s { s s s { s εs k s s s s s s s s s s s s s s s s s 罥Zs s ννs s s s s s s 1ƭcs s s s 9s s 1Bs s s s s ƔνBs s s s k s s s s s s s cBs s s s s s s s s s s s s s s 9 s s { s s s { s s s { s s s ss s {ƽcs s s {{s s ss { s s Bs {s s c{ s ƵsƔ{ s s s { 1ƔΔΥνν{ֽννν{Bs ss s s s s { s s s { s s s J s s s s s s s s s s s s s s s s s ֵ{s s s s Ɣƽ{s s s s s s s Rֵs s s s Bs s s Υ9s s s s s s Rs s s s s s s s s s s s s s s s ) { s s s s s s s { s s s { s { s Bνs s s {!s ss ss { s Ɣs { s { s Rs ss ƔRs s s { s {s {Υs s { s s s { s s s { s s s { s s s s s s s s s s s s s s s s s s s s s s s ֵƵss s s s s s s s Bs s s s cs s s s RΜ!s ss s s ssJs s s ƽ{ֵν֭ƔZ!{s s s s s s s s s s s s s s s s s s s s s s s { s s s { s s s s 1֜{ss { s Bs {s ss { s ss 9{s { s s !s s { s {ƵsΥ!s s {s s s { s 1Ƅs { s s BΥs s { s { s { s s s 答1s { s s s { s s s { s s s { s s s { Ɣs s s s s s s s s s s s s s s !Ɣ{s s s s s Rs s s s s s s s s 1s s s ss cνs s s s s s s !JννR)ss s s s k s s s s s s ֵs s s s s {Υs s s s s s s s s s {νƽ{{s s s s s s s s s s s s s s s s s s s s s { s { s s s { s s s { s s s { ννs s s ss sνƔ{s s s { s s s { s Ɣs s s {s { s { s { s s s s s { s s s {s s s { s s s { s { s { ֔s { s { s s s ֥Υs s { s { s { s { s { s 191s s s { s s s { s s s { s s s { s s s { s { ƌs s s s s s s s s s s s s s s s s s {νν{s s s s s s !1s s s s s s s s s s RΜs s s s s s s Μ!s s s s s s s k s s s s s s s s s s s s s s s s Υs s s k s s s s cΥs s s s ss s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s Ɣs s {s s s { s s s { s s s s s ss { s s 1ƵsƔ֭νBs {s { s ss { s Ɣs s s { s s s { s s s s !s s s s s { s 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{s { s { s s s ss s s { s s1{s { s s s { s s s { s s s { s s s { s s s ν{ s s s { s s s ss s 9Ɣ{s {s { s { s s s { s s s { s s s { s s s s B Bs s k s s s s s s s s s s s s s s s s s s s {Bν{νZ1s s s Υ1s s s s Rs s s s s s s s s s s s s s s s s s s ƽs s s s s s s s s s s s s s s s s s s s !Ƶss s s s s s s s s s s !cs s s s s s s s s s s s s s s s s s s s s s B B{ s { s { s s s { s s s { s { s ss s s !ΥƔc{ s s s { {s { s s s { s s s { s s s { s s s ƭcs s s { s s s { s ss s s s s ss s s { RBs s { s ss ss { s { s s { s s s s s { s s s { s s s { s s s { s s B Bs s s s s s s s s s s s s s s s s s s cJs s s s s s Υs k s s s s s s s s s s s s s s s 1s s s s s s s s s s s s s s s {ν{νs s s s s s s s s s s s Rs s s s s s s s s s s s s s s s s s s s s B Bs s { s s s { s s s { s s s { s { s 1祌1ss s s s s s {s s s s s s { s s s { s s s { BR{ s s s { s s s {s ss { s 1Ɯ!s s ss s s s s s s Ƶsֵ{ s s s { s s s { s s s { s s s { s s s { B Bs s s s s s s s s s s s s s s s s s Ɣs s s s s s s s εss s s s s s s s s s s s s s s Υνs s s s s s s s s s s s s !)s s s s s s s s s !s s s s s s s s s s s s s s s s s s s s s B 9s s s s { s s s { s s s { s ss { 1s s s { s s s s νƔss s s s s s s { s s s { s { νs s { s s s { s s s { s sֵޔs s s s s s s { s s ΥBs s s s s { s s s { s s s { s s s { s s B {s s s s s s s s s s s s s s s s s Ɣs s s s s s s Bs s s s s s s s s s s s s s {νs s s s s s s s s s s s!ƭcs s s s s s s s s !ks s s s s s s s s s s s s s s s s s s s B s s s { s s s { s s s { s s s { s s B{ s s s { s s s 1s { s { s { s s s { s s s JƵs{ s s s { s s s {s s s εsƔs s ss { s s s {s νֽs s s { s s s { s s s { s s s { s s s { B罵 s s s s s s s s s s s s s s s s s s Bs s s s s s s s ƽ{Bs s s s s s s s s s s s s 9Bs s s s s s s s s s s s Μs s s s s s s s s s s Μs s s s s s s s s s s s s s s s s s s s B祥{ s { s s s { s s s { s s s { s ss { 1{ s { s { s { s {Bs s s { s s s { s s s { s Ƅ!s s { s s s { s { s {s s s { s ss { s s s { {Ɣs { s s s { s s s { s s s { s s s { s s ƵsƄﵵ s s s s s s s s s s s s s s s s s s νޔs s s s s s ss s s Ƶs9s s s s s s s s s s s s s νޔs s s s s s s s s s s k s s s s s s s s s s s s s s Ɣν{s s s s s s s s s s s s s s s s s s s s ν s s s { s s s { s s s { s s s ss s !νs s s { s { s s s { s ֵ1s { s s s { s s s { s s s Bέs { s s s { s s s s s ss νΔ{ s s s s s s s { s { s { s BƄs { s { s s s { s s s { s s s { s s s { ƽƄ s s s s s s s s s s s s s s s s s s s Ɣs s s s s s s s s s s s {s s s s s s s s s s s s s s B)s s s s s s s s s s s s s 1cs s s s s s s s s s s s s s s s 1Ɣ9s s s s s s s s s s s s s s s s s s s s νƽ s { s s s { s s s { s s s { s s s ss s Υ眄!{s { s {s ss { s s s s {Ɣ{ s s s { s s s { s s s { s Ɣ{ s s s { s s s { s s s { s { s ss { s s s s s ss { s s s { s s s {s BBƭcνs { s s s { s s s { s s s { s s s { s sν焄 s s s s s s s s s s s s s s s s s s s s s ν{Υ{s s s s s s s s s s s s s s s {֥cs s s s s s s s s s s s s s s Bs s s s s s s s s s s s s s s !)s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s ν s 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