New Member Forms W-4 (2026) HRA WRA authorization Fund Participant Information Insurance SPD (2024) Pension SPD (2025) Request Form NameThis field is for validation purposes and should be left unchanged.Name(Required) First Last Year Born(Required)Phone(Phone OR Email Required)Email(Phone OR Email Required) Request Type(Required) PTO Unemployment Vacation Other Other Request Type(Required)PTO Dates(Required)Date Add Remove( Click (+) to add more dates. Maximum 6 rows per submission)Vacation Start Date(Required) MM slash DD slash YYYY 2nd Week Vacation Start Date MM slash DD slash YYYY (Not Required for Single Vacation Week Request)Unemployment Weekending Date(Required) MM slash DD slash YYYY Weekending date must be a SundayHow would you like to receive your benefit?(Required) Mail Pickup (If "Mail" is selected, benefit will be mailed to the address we have on file.) Health Insurance Forms MVP Enrollment Form MVP Election Form (26-27) Delta Dental Election Form (26-27) Empire Vision Election Form (26-27) Ullico Life Insurance Form Waiver of Coverage Form (26-27) Insurance Claim Form Summary of Benefits & Coverage Summary of Benefits and Coverage - Low (2026) Summary of Benefits and Coverage - Middle(2026) Summary of Benefits and Coverage - High (2026) Summary Notice of Privacy