Member Advisory Group: Sign Up

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?
Please choose your/the member's program:
These meetings will be offered in either English or Spanish. Would you like to attend your selected meeting(s) in English or Spanish?

STAR/CHIP MAG Meeting Dates
These meetings will be presented either in person or virtually. Would you like to attend in person or virtually?
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:
* If meetings run out of availability, please check back again soon.

STAR Kids MAG Meeting Dates
These meetings will be presented either in person or virtually. Would you like to attend in person or virtually?
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:
* If meetings run out of availability, please check back again soon.

Please provide the following information:
Member ID Number
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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?
Please provide us with your Legally Authorized Representative's Information:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Should be Empty:

STAR/CHIP MAG Meeting Dates