Enroll in Your Benefits with UE Local 150

Your Information

Please review and confirm your personal information below. These details are used to determine your benefit rates and eligibility.

Email^*

Prefix

First Name^*

Middle Name

Last Name^*

Suffix

Gender^*

Cell Number^*

Date of Birth^*

Zip Code^*

Annual Salary^*

/year

Hours Worked Per Week^*

Have you used tobacco in the past 12 months?^*

Has a physician declared anyone to be insured not capable of full-time work?^*

Include Spouse in Coverage?^*

Include Children in Coverage?^*

SSN

Member SSN^*

Confirm Member SSN^*

Address

Physical address, no PO boxes

Street Address^*

Address Line 2

City^*

State^*

Zip Code^*

Identification

The Patriot Act requires this information to establish your account with our Federal Banking partner

Type^*

Issuer^*

Number^*

Issue Date^*

Expiration Date^*

US Citizenship

Is the member a US Citizen?^*

Employment Info

Employee ID

If applicable, used to identify the employee in the employer's system

Job Hire Date^*

The date the employee was hired

Job Title^*

The employee's job title or position

Effective Date

01/01/2026

Selected Options

No selections have been made.

No employee

No employee selected or available for enrollment.

Create Your Account Password

Setting a password is optional. If you choose not to set one now, we will email you a link to set one later.

Password (Optional)

Must be at least 8 characters. Leave blank to receive a password setup link via email.

Employee signature^*

Signed: 11/23/2025

City where signature is being collected^*

State where signature is being collected^*

Submitting your enrollment…

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