Case Managers Registry(PT)

After you watch the 2 minute video above, complete the registration form below.

~This is the Case Manager, Residential Managers, Community Orgs/Coordinators Registration Dept for Authorized Lifeline and AHIP Certified Agents.

~We Authorize You To Assist Your Clients Obtain Our Lifeline, ACP and M.A. Plans.

Case Mangers gain significant credibility providing these essential services to their clients.

You make a big difference helping people with these essential services.

Company/Organization Name

Identity Information

1. First Name *

2. Last Name

3. Date of birth *

Contact Information

4. Cell Phone *

5. Email *

6. City

7. State

Lifeline/AHIP Experience

~Have you worked with a lifeline company or held a professional license and had your AHIP certification before?

8. Lifeline/MA Experience( No experience is required)

Take A Selfie for Your Badge Picture

9. Badge Picture

Badge Picture

badgepic

Authorization

11. Name Of Person That Referred You This Registration?