Become a Champion for Coverage

All fields are required
Organization Name 
Point of Contact(First and Last Name) 
Email (Used to receive Champion email notifications) 
Organization Street Address 
City 
State 
ZIP 
Organization Web Address(Optional) 
Phone Number(optional) 
Please tell us what your Organization is doing to promote the Affordable Care Act and Health Insurance Marketplace (optional) 
Disclaimer: By submitting your organization’s name, you aren’t entering into any legally binding contract with HHS, however you are consenting (1) to having the organization’s name publicly listed as a “Champion for Coverage”, and (2) to refrain from suggesting or implying that designation as a “Champion for Coverage” constitutes an endorsement of the organization, its policies, activities or products by HHS or the Federal government. In addition, participating “Champions for Coverage” entities do not become agents, employees or representatives of HHS for any purpose, and undertake their efforts without any expectation of compensation from HHS or any Federal agency.