Benefit Fair Supplies Form

Your agency ID

Quantity of Open Season packets needed *

Shipping contact full name *

Shipping contact email address *

Shipping contact phone number *

Agency name *

Street *

City *

State/Province (two-letter abbreviation) *

Zip *

Which category best describes the people who'll be using these Open Season packets? *
--None-- Current federal employees outside of the D.C. area Current federal employees in the D.C. area (including northern Virginia and southern Maryland) Military retirees Current TRICARE members Tribal employees NARFE members