COBRA Model Election Notice Form

You have three options to access this form:

1) Click this link for a web page version of the form.
     You can print out and fill in, but cannot modify this form.

2) Right Click this link to download a copy of the Microsoft Word document to your computer. When you RIGHT click the link, choose "Save Target As" and then designate a folder on your computer's hard drive. Then click the "Save" button and the file will be downloaded to your computer. You can then open the file in Word and make changes as you wish.

3) E-mail Katie and ask her to send you a copy of the form.