Step 1. Tell Us About You

Are you a member of California Retired Teachers Association (CalRTA)?

Thank you for your interest in this member program.

As part of your enrollment you are also agreeing to begin membership in CalRTA. You can view dues amounts and details at https://calrta.org/join-us

Have you had Dental coverage within the last 60 days?

Prior Dental Carrier Name

First Name

Middle Name

Last Name

Birthdate Month

Birthdate Day

Birthdate Year

Email Address

Phone Number

Sex

Street Address

City

State

Zip Code

By providing your contact information and clicking the Next button below, you consent to receive emails and/or standard mail, automated calls and texts from AMBA, including but not limited to information regarding other products or services offered through AMBA and/or your employer or sponsoring organization. Consent is not required nor is it a condition of any purchase or to obtain a quote. If you do not wish to consent but would still like a quote, please call us at 1-844-385-4359. You acknowledge that your electronic consent shall constitute your electronic signature. Message and data rates may apply.

Rest assured, we do not sell your information to any third parties. All information is secure and protected. For details see our Privacy Policy.

CALIFORNIA HEALTHCARE LANGUAGE ASSISTANCE PROGRAM NOTICE TO INSUREDS

STATEMENT ON CONSUMER CONSENT TO THE USE OF ELECTRONIC TRANSACTIONS, SIGNATURES AND RECORDS (Consent Statement)

Step 1. Tell Us About You

STATEMENT ON CONSUMER CONSENT TO THE USE OF ELECTRONIC TRANSACTIONS, SIGNATURES AND RECORDS
(Consent Statement)