Adult Dependent Enrollment

If you wish to enroll an adult dependent,
first print/download the directions and form and then you may use any of the methods below to submit the form.

Be sure to include your signature
(No information will be accepted without a signed form)


PRINT/DOWNLOAD

FAX
1.) Complete the form, including signature.
2.) Then, FAX it to 763-416-6196

EMail
1.) Complete the form, including signature
2.) Scan the form
3.) Create a new email using this link: Enrollment
         or
      Use your email and send to
enrollment@ibew292benefits.org
4.) Insert/attach the scanned form into the email.
5.) Send the email
US Post Office
1.) Complete the form, including signature.
2.) Then, return to address on the form


 


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