RSSA Request

If you qualify* for the RSSA discount, we will send you an email with a code to use when purchasing the training. Allow 24-48 hours for your submission to be reviewed.

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

NPN*

Resident State*

Comments/Questions

*Agent must have 3+ Active MAPD Contracts with GarityAdvantage to qualify for the RSSA special offer. Need contracts? Get started here: garityadvantage.com/getcontracted

Or Call/Email us to discuss your options:
800-234-9488 / recruitment@garityadvantage.com

By completing this form and providing your name, email, postal or residential address, and/or phone number, you hereby expressly consent to receive electronic and other communications from GarityAdvantage Agencies, over the short term and periodically, including email and text communications. These communications will be about their services, new product offers, promotions, and other matters. You may opt out of receiving electronic communications at any time by following the unsubscribe instructions contained in each communication, or by sending an email to seniormarket@garityadvantage.net. You agree that these electronic communications satisfy any legal requirements that communications or notices to you be in writing.

For GarityAdvantage use only

Date Reviewed*

Date

Review by*

First NameLast Name

Approved for discount*

Territory Manger*

Notes