Name

Address

City, State, Zip

Email

Phone

Which health plan are you a member of?
Anthem Medicare Advantage
Traditional Medicare with United America Supplement
Kaiser

Are you enrolled in Medicare?
Yes
No

Indicate any contact information that you would like included in the PRO Member Directory:
Your address Yes No
Your phone number Yes No
Your email address Yes No

Unless you authorize PRO to list contact information in the Member Directory, no contact information for you will be available on the PRO website. The Member Directory is password protected. To obtain the password, email a request to:
webmaster@peraltaretirees.org.