Bridge & Structural Iron Workers
Member Signup Form

Sign Up Today
Thank you for your interest...fill in this short form to become a WHFA Member Participant.

As mentioned in our FAQ page, there is a one time charge of $2.00 per participant, thereafter payment of 20% of the savings to UPHS ( Union Pacific Health Systems ) and 10% to WHFA are required. If there are no savings then there is no charge.

Our administration office will send out via Priority Mail, a signup form already filled out with the information entered below. Just review, sign the agreement, pay your one time fee, and return to us in the envelope provided. If you have any other questions or concerns, please feel free to e-mail our administration office by clicking here.

Your First Name: *
Your Last Name: *
Member Name: *
(example: Eighth District Electrical Benefit Fund)
Locals:
Administrator: *
E-mail: *
URL: (www.yourdomain.com)
Street Address:
Mailing Address: *
City: *
State: *
Zip: *
Phone: *
Fax: *
Contact Person: *
Covered Lives: (How many) *
* Required

 
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