Enroll Now to Start
To enroll, click on the link
below to open a printable Adobe® Acrobat file on your computer.
Just print the form and provide us with your information.
Mail it to us with your enrollment fee and your first month,
annual or two-year membership fee.
You can also bring it with you when you visit your dental
There is an Enrollment Fee of $25 for individuals and
individuals + spouse.
Enrollment fee for any family plan is $40.
|Individual & Spouse
* Family Consists of a Member, Spouse and dependent children under
age 22 or a Member plus dependent children.
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PO Box 7243
Waco, TX 76714
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