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Required fields are noted with an asterisk *.

* First name			* Last name
* Phone number By providing a telephone number and/or an email address, I agree that Capital Blue Cross, its affiliates, subsidiaries, and/or agents may communicate with me by phone, text, or email for transactional, informational, or marketing purposes, including calls and messages made using an automatic telephone dialing system or pre-recorded voice messages. I understand my consent is not a condition of purchasing any goods or services.
* Email address			I do not have an email address.
* Tracking code			I do not have a tracking code.

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Updated January 1, 2025

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