Fillable enrollment and beneficiary form scptac

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EE-F001 Southern California Pipe Trades Trust Funds 501 Shatto Place, 5th Floor Los Angeles, CA 90020 (800) 595-7473 or (213) 385-6161 Enrollment & Black or Blue Form Please Print & UseBeneficiary Ink Only NOTE: BE SURE TO COMPLETE ALL APPLICABLE SECTIONS Section A. Member's Information Name Address S.S.# Phone # Local Union # Date of Birth Section B. SCPT Health & Welfare Fund List all dependents...
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enrollment and beneficiary form scptac
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