Language
English (US)
Español
Member Advisory Group: Sign Up
As a participant in our Member Advisory Group, you can make a difference. A Member Advisory Group allows you to share your opinions about a variety of topics. Join us by signing up below!
Are you a Cook Children's Health Plan Member or a Member's Legally Authorized Representative?
*
Member
Legally Authorized Representative
Please choose your/the member's program:
*
STAR
CHIP
STAR Kids
These meetings will be offered in either English or Spanish. Would you like to attend your selected meeting(s) in English or Spanish?
*
English
Spanish
Back
Next
STAR/CHIP MAG Meeting Dates
These meetings will be presented either in person or virtually. Would you like to attend in person or virtually?
*
In person
Virtual
Please select which of the following meetings you would like to attend in person:
*
Please select which of the following meetings you would like to attend virtually:
*
Back
Next
STAR Kids MAG Meeting Dates
These meetings will be presented either in person or virtually. Would you like to attend in person or virtually?
*
In person
Virtual
Please select which of the following meetings you would like to attend in person:
*
Please select which of the following meetings you would like to attend virtually:
*
Back
Next
Please provide the following information:
Member ID Number
*
Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Please provide the following information for each CCHP Member in your household:
*
Do you have a Legally Authorized Representative?
*
Yes
No
Please provide us with your Legally Authorized Representative's Information:
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Register
Should be Empty: