Adult Dependent Enrollment
Let’s take a look at
your benefit options.
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/spouse signature.
(No information will be accepted without a signed form)
Fax
- Complete the form, including signature
- Then, FAX it to 763-416-6196
- Complete the form, including signature
- Scan the form
-
Create a new email using this link: Enrollment
or
Use your email and send to enrollment@ibew292benefits.org - Insert/attach the scanned form into the email
- Send the email
US Post Office
- Complete the form, including signature
- Then, return to address on the form