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 GROUP ENROLLMENT FORMS To view the enrollment forms you will need Adobe Acrobat Reader. If you do not have this program, click on the following icon to download it for free. 
Once you have printed and completed the appropriate form(s), please return them to our office. Please feel free to call us at 1-800-875-4490 if you have any questions. Regence BlueShield/RegenceCare Regence BlueShield Employee Enrollment & Change Form RegenceCare Employee Enrollment & Change Form Regence BlueShield/RegenceCare Waiver Form Regence BlueShield Cancellation Form RegenceCare Cancellation Form Premera Blue Cross Premera Blue Cross - Enrollment and Change Application Premera HealthPlus - Enrollment Application Premera Blue Cross - Cobra Application Premera Blue Cross - Continuation of Coverage Application Premera Blue Cross - Domestic Partner Affidavit Fortis Employee Application Guardian Group Insurance Enrollment and Record Form First Choice Health Plan Enrollment/Status Change Form WAHIT Employee Enrollment Application NW Technical Trust Employee Enrollment Application Pacific Life Employee Enrollment Application |
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E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.) or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411 Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424 Serving all of Washington at 800-875-4490, Seattle at 206-682-1628, Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291. Copyright© 1998-2007, Maddock & Associates | Privacy Statement Problems viewing this page? Contact the webmaster. |
