MEDICARE CONSENT 

If, at any time, I choose to cancel this authorization, I understand that I must do so in writing by sending my name, address, date of birth and member ID number to ASIREM’ an Expert Media Group LLC and Expert Financial Group LLC Brand, 1821 S. Dixie Highway, Pompano Beach, FL 33060 
 
Unless cancelled as noted above in writing, this consent is valid until I cancel my Humana membership. For customers in the following states: CA, CT, GA, IL, MA, MD, MT, NC, NJ, NV, OH, OR and VA, consents will expire in compliance with applicable state laws. 
 
I understand it's ASIREM’ an Expert Media Group LLC and Expert Financial Group LLC brand policy not to disclose my personal information to third parties-except as permitted under the federal privacy laws. ASIREM’ an Expert Media Group LLC and Expert Financial Group LLC Brand is required to let me know that should my personal information be disclosed to third parties, the information can be redisclosed and may not be protected by privacy laws. 
 
I understand that ASIREM’ an Expert Media Group LLC and Expert Financial Group LLC Brand may receive direct and indirect compensation from third parties as a result of the sale of certain products. 

 
I authorize ASIREM’ and Expert Media Group LLC and Expert Financial Group LLC Brand affiliates to send the above-requested information on the health-and non-health-related products and services using my name and address, and (if provided), my gender, date of birth, phone number and email address. 

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