TRI-CITY MEDICAL CENTER - DISTRICT

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		District Resident Benefit Program Benefit List

		District Resident Benefit Program Details & Disclosures

We recognize that many residents in the Tri-City Healthcare District (TCHD) support the hospital and as such we want to show our appreciation by offering a package of benefits.

Please take a moment to read the District Resident Benefit Program Benefit List form and the District Resident Benefit Program Details & Disclosures

You can find out if you are a TCHD resident now: http://www2.sdcounty.ca.gov/rov/Eng/Edistrict_query.asp Once you complete the District Query form, a list of the Districts for which you reside will appear. If you are in the Tri-City Healthcare District, it will appear on your list (probably near the bottom).

Fill out the form below to join the Tri-City Healthcare District Resident Benefit Program. If registering multiple people, please complete and submit a form for each individual.

* Indicates a required field

Title:
First Name:*
Last Name:*

Address:*
City:*
State:*
Zip:*

Phone:*
Email Address:*

Date of Birth (MM/DD/YYYY):*	/ /

Where did you hear about the TCH DRBP Program?*

Please complete and submit one form for each resident. *	I am a TCHD District Resident I have read and I accept the conditions of the details and disclosures document (located on the left side) I am interested in receiving a flu shot in the fall of 2008. I am interested in receiving a Free Heart Health Assessment. Sign up for our e-newsletter

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