Event Agency Contract by vtm53740

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									            Attachment 1: Group Sales Presentation Data Template




MA Organization or PDP Sponsor Name:
CMS Contract Number(s) of Plan(s) To Be Sold:




                                                                                    Description of Venue         Venue
                             Name of Brokerage Firm/ Agency/Sales                   (e.g., sales event at senior Phone                                                                    Event Contact Contact Phone Contact e-mail
Date: dd/mm/yy Time          Associate                            Venue Name        center, health fair)         Number    Venue Street Address   Venue City Venue State Venue Zip Code   Person        Number        Address
Example:

       05/03/07     1:00 AM John Doe and Associates             Family Restaurant   MA-PD product sales event 555-555-1212 123 Any Street         Any Town   OR                   97070 John Doe        555-555-1111   jdoe@email.net




            2/1/2011, 11:45 AM                                                                                                                                                                                                          1 of 1

								
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