Welcome to SHIPtalk Registration

Welcome to SHIPtalk Registration! Registration on the SHIPtalk web site is limited to people who work with the State Health Insurance Assistance Program grant from the Centers for Medicare & Medicaid Services.

Check this box _only_ if you are a member of Congress, CMS Staff, or of an agency that supports SHIP activities but does not provide SHIP counseling. Note: If you are a SHIP counselor or from an agency that works directly with the State SHIP program, do not check this box.
*First Name
*Last Name
*Agency
City
*State	Please Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Unknown Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Unspecified
Zip
*Phone #
*Email
*Username	You may use any combination of letters and numbers, up to 20 characters to create your username and password.
*Password
*Confirm Password

(* - Indicates required field)