Mediterranean Wellness Program
Certificate of Completion

Congratulations!

You have completed at least 75% of the Mediterranean Wellness Program Curriculum and now are eligible to submit your claim to the FOREIGN SERVICE BENEFIT PLAN (FSBP) for reimbursement of the program fee of $140.00 (subject to availability).

Submitting your claim is easy
Simply complete the fields below and send us your claim. Your claim will be processed under the Plan's Nutritional Counseling Benefit.

Member First Name:	cert.first
Member Last Name:	cert.last
Member ID Number:	cert.c1
Date of Completion:	cert.c2
Rate the program (1-5):	cert.c3

Member's Signature: _______________________________________________       Date: ____________

Please submit your claim through one of the following methods:

- Via our secure Web site (PDF only):
https://www.afspa.org/site/insurance/fsbp/fsbp_askafspas_claim.html
- Via e-mail: health@afspa.org
- Via fax: (202) 464-4508
- Via Mail:
FOREIGN SERVICE BENEFIT PLAN
1716 N Street, NW
Washington, DC 20036-2902